Inpatient Unit Heart Failure Discharge Volume Predicts All-cause 30-Day Hospital Readmission.

Published

Journal Article

BACKGROUND: All-cause 30-day hospital readmission is a heart failure (HF) quality of care metric. Readmission costs the healthcare system $30.7 million annually. Specific structure, process, or patient factors that predispose patients to readmission are unclear. OBJECTIVE: The aim of this study is to determine whether the addition of unit-level structural factors (attending medical service, patient-to-nurse ratio, and unit HF volume) predicts readmission beyond patient factors. METHODS: A retrospective chart review of 425 patients who resided in Maryland and were discharged home in 2011 with the primary diagnosis of HF from a large, urban academic center was conducted. RESULTS: The patients were predominately (66.6%) black/African American, with mean (SD) age of 62.2 (14.8) years. Men represented 48.2% of the sample; 32% had nonischemic HF, 31.3% had preserved ejection fractions, 25.4% had implantable cardioverter defibrillators, and 15.3% had permanent pacemakers. Average length of stay was 6.0 days. All-cause 30-day hospital readmission rate was 20.2%. Inpatient unit HF discharge volume significantly predicted readmission after controlling for patient factors. CONCLUSIONS: The study found that discharge from inpatient units with higher HF discharge volume was associated with increased risk of readmission. The findings suggest that in caring for patients with severe HF, inpatient unit HF discharge volume may negatively impact care processes, increasing the odds of hospital readmission. It is unclear what specific care processes are responsible. The discharge period is a vulnerable point in care transition that warrants further investigation.

Full Text

Duke Authors

Cited Authors

  • Dordunoo, D; Thomas, SA; Friedmann, E; Russell, SD; Newhouse, RP; Akintade, B

Published In

Volume / Issue

  • 32 / 3

Start / End Page

  • 218 - 225

PubMed ID

  • 27028590

Pubmed Central ID

  • 27028590

Electronic International Standard Serial Number (EISSN)

  • 1550-5049

Digital Object Identifier (DOI)

  • 10.1097/JCN.0000000000000331

Language

  • eng

Conference Location

  • United States