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Transfer and readmission of patients between acute and community hospitals: a retrospective review

Background: Patients who are discharged from acute
hospitals to community hospitals are often readmitted. We
conducted a medical record audit for a sample of patients
who were admitted to the acute hospital (AH), transferred to
a community hospital (CH) and readmitted to the same acute
hospital over a 12 month period.
Aims: 1. To examine characteristics of patients
who were readmitted to an AH after a CH stay.
2. To examine the appropriateness of actions prior to
readmission from CH to AH.
Methods: A retrospective review of patient records was
undertaken between April 2012-March 2013 for one AH and
ten CHs serving the same geographical location. Phase 1
audit entailed detailed review of the patient stay in AH and
CH. We reviewed the complete AH and CH episode of care
for 25 patients, giving 50 episodes of care. The Phase 2 audit
entailed detailed review of the decision processes underpinning
transfer/readmission for 40 patients and expert review of the
appropriateness of the transfer.
Results: The median age of the patients was 83 years
(IQR 7.50). Median length of stay for the AH episode was 9
days (IQR 11.75). The patients reviewed were physiologically
unstable during AH and CH episodes of care. However, none of
the patients were acutely unwell in the few hours before transfer
from AH to CH. Re-admission to the AH was undertaken out
of hours (including weekend day time) for 39 (55%) patients.
In Phase 2 most readmissions were deemed appropriate
(31/40; 77.5%). Out of hours readmission across both phases
was significantly associated with out of hours transfer (χ2 4.812,
p=0.028) and longer AH length of stay (χ 2 12.751, p=0.047).
Conclusions: Timing of transfer from AH to CH should
be optimised to ensure patients are discharged when the full
range of services is available. CH services could be configured
differently with diagnostic and access to doctors provided for
longer hours in a smaller number of CH.


Ruth Endacott

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