ED Visits, Work Conditions Factor into Hospital Readmission Rates

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
Elderly man readmitted to the hospital

A new study confirms a phenomenon long observed by home health workers: emergency room visits are an indicating factor for unplanned readmissions. A study published in the August issue of the Journal of Evaluation in Clinical Practice found that the strongest predictor of readmission is a high number of previous emergency department visits.

Other predictors include being discharged on a Friday and a long length of stay. The most common reasons for readmissions were cardiovascular and pulmonary diagnoses, and 10.4% of all readmissions were due to complications.

The researchers said that because multiple ED visits and longer patient stays are linked to higher readmission rates, hospital clinicians must work with caregivers and primary care physicians to coordinate a smoother transition from hospital to home, especially for patients discharged on Friday.

This research confirms an earlier study published in the Annals of Internal Medicine showing that a patient’s risk factors for readmission change during the 30 days post-discharge. Early readmissions (within seven days of discharge) were associated with the acute illness the patient was hospitalized for, but later readmissions (eight to 30 days) were likely to be due to a patient’s chronic illness.

The study authors recommended more robust post-discharge monitoring to ease transitions, ensure patients adhere to medications schedule, and increase attendance at follow-up appointments.

Working conditions affect patient outcomes

Olga Jarrín, PhD, RN, of Penn Nursing Center’s Health Outcomes and Policy Research, says another important step must be taken to reduce admissions rates. “The best outcomes for patients, including the fewest hospitalizations and transfers to nursing homes, are achieved by home health agencies that provide supportive work environments, enabling nurses to focus on patient care,” she says.

Jarrín is the lead author of “Home Health Agency Work Environments and Hospitalizations,” published in the October issue of Medical Care. It investigated rates of hospitalization and success in maintaining patients in community living arrangements in 118 Medicare-certified home health agencies and found that hospitalizations, including both acute and long-term stays, were lowest for patients receiving services from organizations where nurses reported excellent working conditions.

“Home care nurses are often so burdened with non-care responsibilities that patients and their families fail to receive the help they need,” Jarrín says. “Home health agencies should be incentivized to enable nurses to practice to the highest level of their training and maximize time with patients, thus optimizing patient outcomes and reducing unnecessary use of expensive hospital and institutional care.”

Want to learn more about factors that predict hospital readmissions? Read our recent post that delves further into the surprising complexities of this issue.

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