Understanding Readmission Rates
We strive to avoid any unplanned readmissions to our hospitals after a previous hospital stay. UTMB defines hospital readmission as patient admission to a hospital within 30 days after being discharged from an earlier hospital stay. An example would be a patient who is readmitted to the hospital for a wound infection related to a surgical procedure following an initial hospital stay. There are a number of situations that can lead to patient readmissions. Some are not preventable and not all readmissions are related to a previous visit.
What are preventable risk factors? (click here to learn more)
- Patients who may potentially experience problems with medications, such as individuals who must take multiple medications or are on high-risk medications (e.g., blood thinners, insulin, narcotics, etc.).
- Patients who screen positive for depression or who have a history of depression.
- Patients with a principal diagnosis or reason for hospitalization related to cancer, stroke, diabetic complications, COPD, or heart failure.
- Patients with frailty or other physical limitations that impair or limit their ability to significantly participate in their own care (e.g. perform activities of daily living, medication administration, and participation in post-hospital care).
- Patients with limited knowledge of or familiarity with basic health information and services.
- Patients with poor social support, such as the absence of a reliable caregiver to assist with the discharge process and to assist with care after the patient is discharged.
- Patients who experienced an unplanned hospitalization in the six months prior to the current hospitalization.
- Patients who are currently undergoing palliative care.
Calculating the Readmission Rate
The Readmission Rate is calculated using the total number of readmissions for adults aged 18 and older that occurred within 30 days of discharge.
The 30-day all-cause readmission rate is the percentage of patients who returned to the hospital within 30 days of discharge from the prior admission. This percentage is calculated by dividing the number of readmissions by the total number of patient discharges for the reported time frame.*
*Obstetric patients and newborns are excluded from UTMB's calculation because we have such a high volume of childbirths at UTMB (they account for about 1/3 of our patient discharges). These patients (mothers and babies) have a very low readmission rate (good). Therefore, because there are so many patients in this group who experience a very low readmission rate, we omit them from our calculation to better understand our overall performance in all other inpatient areas.
Over the last year, UTMB Health has undertaken significant efforts to reduce preventable hospital readmissions. Our work to prevent readmissions involves identifying and understanding a patient’s risk for adverse events after discharge before they leave the hospital. By identifying these risks early on, the health care team can begin to mitigate those possibilities while the patient is in their care.
For patients with frequent hospitalizations, we are developing plans for a more intensive support outside the hospital environment in order to help this population establish a medical home and better understand what services and assistance may best help them self-manage disease. This will also allow us to better understand socioeconomic/non-medical needs and to potentially help mobilize community resources for some patients.
For our elderly population, our Acute Care of the Elderly team has a project underway to close gaps in care associated with transitions between hospital and skilled nursing facilities. We will be supplementing clinical staff who have a formal presence in these facilities and taking advantage of our Epic EMR capability to exchange information electronically at discharge.
We will also be extending our community health care program to enlarge its case management in the community to a broader base of patients, and to focus on disease states with recurring readmission risk. Readmissions are not necessarily an indication of survival, but can be an inconvenience for patients and families.