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

Z Shalchi, S Saso, HK Li, E Rowlandson and RC Tennant
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DOI: https://doi.org/10.7861/clinmedicine.10-2-202a
Clin Med April 2010
Z Shalchi
Acute Medical Assessment Unit, Northwick Park Hospital, North West London Hospitals NHS Trust
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S Saso
Acute Medical Assessment Unit, Northwick Park Hospital, North West London Hospitals NHS Trust
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HK Li
Acute Medical Assessment Unit, Northwick Park Hospital, North West London Hospitals NHS Trust
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E Rowlandson
Acute Medical Assessment Unit, Northwick Park Hospital, North West London Hospitals NHS Trust
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RC Tennant
Acute Medical Assessment Unit, Northwick Park Hospital, North West London Hospitals NHS Trust
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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.

Footnotes

  • Please submit letters for the Editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk

  • © 2010 Royal College of Physicians

References

  1. ↵
    1. Landrum L,
    2. Weinrich S
    . Readmission data for outcomes measurement: Identifying and strengthening the empirical base. Qual Manag Health Care 2006; 15: 83–95.
    OpenUrlPubMed
  2. ↵
    1. Mistiaen P,
    2. Francke AL,
    3. Poot E
    . Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review. BMC Health Serv Res 2007; 7: 47.doi:10.1186/1472-6963-7-47
    OpenUrlCrossRefPubMed
  3. ↵
    1. Parker SG,
    2. Peet SM,
    3. McPherson A,
    4. et al
    . A systematic review of discharge arrangements for older people. Health Technol Assess 2002; 6: 1–183.
    OpenUrlPubMed
  4. ↵
    1. Townsend J,
    2. Piper M,
    3. Frank AO,
    4. et al
    . Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial. BMJ 1988; 297: 544–7.doi:10.1136/bmj.297.6647.544
    OpenUrlAbstract/FREE Full Text
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In response – additional support to high-risk patients can reduce hospital readmissions
Z Shalchi, S Saso, HK Li, E Rowlandson, RC Tennant
Clinical Medicine Apr 2010, 10 (2) 202-203; DOI: 10.7861/clinmedicine.10-2-202a

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In response – additional support to high-risk patients can reduce hospital readmissions
Z Shalchi, S Saso, HK Li, E Rowlandson, RC Tennant
Clinical Medicine Apr 2010, 10 (2) 202-203; DOI: 10.7861/clinmedicine.10-2-202a
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