In response – additional support to high-risk patients can reduce hospital readmissions

We have been heartened by the response to our article, particularly the letters published above. These emphasise our conclusions, highlight further areas of concern and provide solutions for their management.

The term ‘readmission’ is poorly defined.¹ Whereas we limited our readmissions to a period of up to 14 days, Woodard and Conroy considered all patients readmitted within 30 days, and Frank felt three years was a suitable time period.

Nevertheless, it is clear from our data, as well as those cited by our colleagues in response, that readmission is more likely in patients with complex care needs. Frank showed that readmission is more likely in those living alone, while Woodard and Conroy echo our findings that readmission is more prevalent in frail older patients, who generally have increased lengths of stay. Heydtmann introduces a further important group – those admitted with alcoholic liver disease. It is distressing to read of such high readmission and mortality rates in this cohort.

Our article discussed the merits of a multidisciplinary approach in caring for high-risk patients, who have been shown to benefit from adequate discharge planning and aftercare initiatives.^2,3 We read with interest Woodard and Conroy's description of an acute frailty unit, which will likely improve the standard of care provided to older patients, and we await with further data from their experience.

Patients at risk of readmission have been shown to be older and sicker with less social support than other inpatients. They have medical, psychological and social needs that are complex and significant. Our ageing population means the size of this cohort will only increase. Caring for these patients requires a multidisciplinary, holistic approach that seamlessly coordinates care across diverse locations.

As well as adequate medical provision, further investment in effective discharge planning and aftercare strategies, such as the care attendants scheme discussed by Frank,⁴ will need to be implemented. This will require better cooperation between the medical profession and social services, as well as the political will to implement this change. The challenge is significant, but the reward is happier, healthier patients.

• © 2010 Royal College of Physicians