Student Dissertation

Agency : Hospital Re-admissions; Discharge Process; CNS Users

Objective : To study the Re-admissions occurring within 14 days of the discharge in a 540 bedded Super-Specialty hospital from 1st February to 30th April’18

Background : A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Re-admission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems. Hospital readmission rates were formally included in reimbursement decisions for the Centres for Medicare and Medicaid Services (CMS) as part of the Patient Protection and Affordable Care Act (ACA) of 2010, which penalizes health systems with higher than expected readmission rates through the Hospital Readmission Reduction Program. Since the inception of this penalty, there have been other programs that have been introduced, with the aim to decrease hospital readmission. The Community Based Care Transition Program, Independence at Home Demonstration Program, and Bundled Payments for Care Improvement Initiative are all examples of these programs. While many time frames have been used historically, the most common time frame is within 30 days of discharge, and this is what CMS uses.”

Methodology : Study Design: Descriptive study Study Duration: 1st February to 30th April 2018 i.e. 3 months Study Population: All patients admitted to the 540 bedded Super-Speciality hospital in New Delhi from 1st February to 30th April 2018 Data Collection Procedure: Secondary Data was gathered through HIS (Hospital Information System) and CPRS (Computerized Patient Record System) software used in the Hospital. Data Analysis: Descriptive Statistics Study Duration: 3 months (i.e. 1st February to 30th April 2018)

Findings : In a 540 bedded super-specialty Hospital, there were 11864 admissions from the months of February to April’2018. Total 10580 patients were discharged within this time and 102 patients were re-admitted to the hospital within 14 days of discharge. After analyzing all the re-admission cases, it was found that 27 of them were in the month of February 48 in the month of March and 27 in the month of April. 64% of the 102 cases were planned re-admissions due to TPA or patient not fit for surgery, rest 36% were unplanned because of the critical condition or end of the life care of the patient. Preventable re-admissions are those which could be prevented, as the patient was not so critical such cases are 27% out of 102. Unpreventable re-admissions are those which cannot be prevented due to the critical condition of the patient and such cases are 73%. Among all the departments, Cardiology has the highest with 38% of re-admissions with the lowest in Plastic surgery and Vascular surgery with 2%. Re-admissions can be prevented if proper information is conveyed at the time of discharge for those 27% cases. The study showed that the maximum number of Re-admissions was because of Inadequate Post- Discharge Support with 23% of all the reasons.