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Impact of pre-discharge intervention on short term readmission in an academic emergency department in north India

Author: 
Yadav D., Shastry V.G.R. and Kole T.
Subject Area: 
Health Sciences
Abstract: 

Readmissions in the Emergency Department (ED) are multifaceted. In our earlier research1, we found that poorly managed transitions during discharge were the cause of avoidable readmission. Thus, pre-discharge interventions focusing on discharge planning, medication reconciliation, and scheduling a follow up visit prior to departure from the ED were incorporated in practice and studied in this phase of study. For the same, a template of discharge summary was introduced in the electronic health record (EHR) – CPRS in early 2015 which included summary of current ED visit, details of medications and follow up appointment, and was mandated to be co-signed by the Consultant on the shift to ensure cent percent compliance. Thereafter, data was collected from 1st January through 31st December 2016 prospectively and readmissions within 72 hours of index ED registrations were categorized exclusively and hierarchically into: (1) Avoidable readmissions- (1a) Readmissions due to inadequate care, (1b) Readmissions due to poorly managed transitions during discharge; (2) Unavoidable readmissions- (2a) Readmissions due to complications, (2b) Readmissions due to recurrences; (3) Unrelated readmissions (different body systems); (4) Other planned readmissions; (5) Readmissions after LAMA (Leaving Against Medical Advice). It was found that the readmission rate within 72 hours of index ED registration had fallen from 2.46% in the year 2013 – 14 to 1.66%. Furthermore, avoidable short term ED readmission category witnessed a reduction by two and half folds from 36% to 15.70%, from 2013 to 2016. Also, a reduction by a tenth was noted in readmissions due to inadequate care and poorly managed transitions during discharge from the ED. Our analysis suggests that smoothening the transit during discharges by bridging the gap and sustaining the quality of care between hospital and home can promisingly improve patient outcome.

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