Patients discharged from crowded hospital wards face higher readmission risk

After examining hospital discharge rates, researchers found patients discharged from crowded hospital wards were more likely to be readmitted in the next 30 days, according to data reported at the American Thoracic Society 2018 International Conference.

The researchers found the top three predictors of whether a patient will be readmitted "are all modifiable, ward-level factors," lead researcher Rachel Kohn, MD, told Medscape Medical News.

The predictors include the number of patients discharged the same day, the number of medications administered to all patients on the ward that day and the number of patients who occupied a bed that day, Dr. Kohn said.

To analyze readmissions, the researchers examined discharges from the intensive care units — 33 wards — of three Pennsylvania hospitals in 2014 and 2015. The researchers looked at hospital capacity on the last calendar day of the hospital stay for each of the 13,338 patients in the study.

They assessed capacity by seeing how many beds were filled, how many medications were administered, how many patients were transported off the ward, and how many patients required telemetry monitoring, transfusions or a sepsis assessment.

Out of the top three predictors from nine hospital wards for whether a patient would be readmitted in the 30 days after discharge, one factor stood out: "When a lot of people are being discharged on a specific day, it means a lot will be coming back," Dr. Kohn said.

Discharge paperwork and medication checks may not be completed as thoroughly as they should be when the ward is crowded, Dr. Kohn explained. "The more work you're imposing on staff, the more things can be missed," she said.

"We need to look closely at where we might be able to intervene," Dr. Kohn added. If staff members frequently feel overburdened by medication administration, a workload threshold can be set to prompt adding more staff when necessary.

Hospital leaders also can try to revise discharge practices. Dr. Kohn suggests hospitals have a nurse who is responsible for patient transportation, paperwork and medication.

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