Keiki Hinami1, Karl Y Bilimoria2, Peter G Kallas3, Yael M Simons3, Nicholas P Christensen3, Mark V Williams3. 1. Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 E. Ontario Street, 7-727, Chicago, IL 60611, USA. Electronic address: khinami@nmh.org. 2. Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 3. Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 E. Ontario Street, 7-727, Chicago, IL 60611, USA.
Abstract
BACKGROUND: Little is known from patients' perspective about the quality of postdischarge care and the causes of rehospitalization after elective surgery. METHODS: A prospective observational cohort study was conducted. RESULTS: Of 400 patient participants, 374 completed the 30-day follow-up questionnaire (completion rate, 94%). Half of all unplanned rehospitalizations (experienced by 13% of patients) and nonrehospitalization emergency department visits (experienced by 6%) occurred within 10 days of discharge. Patients used emergency departments and were rehospitalized at facilities near their homes (mean distance traveled, 12.1 mi). The most common primary reason for rehospitalization was postoperative complications, according to patient report, clinical records, and administrative data. Poor perceived care coordination was associated with higher readmission risk. CONCLUSIONS: Patients perceive surgical complications as dominating the reasons for rehospitalizations after elective surgery. Strategies to improve care quality around elective surgery at referral centers should target the discharge process and the coordinated management of postoperative complications through care received at regional hospitals.
BACKGROUND: Little is known from patients' perspective about the quality of postdischarge care and the causes of rehospitalization after elective surgery. METHODS: A prospective observational cohort study was conducted. RESULTS: Of 400 patientparticipants, 374 completed the 30-day follow-up questionnaire (completion rate, 94%). Half of all unplanned rehospitalizations (experienced by 13% of patients) and nonrehospitalization emergency department visits (experienced by 6%) occurred within 10 days of discharge. Patients used emergency departments and were rehospitalized at facilities near their homes (mean distance traveled, 12.1 mi). The most common primary reason for rehospitalization was postoperative complications, according to patient report, clinical records, and administrative data. Poor perceived care coordination was associated with higher readmission risk. CONCLUSIONS:Patients perceive surgical complications as dominating the reasons for rehospitalizations after elective surgery. Strategies to improve care quality around elective surgery at referral centers should target the discharge process and the coordinated management of postoperative complications through care received at regional hospitals.
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Authors: Molly J Horstman; Whitney L Mills; Levi I Herman; Cecilia Cai; George Shelton; Tareq Qdaisat; David H Berger; Aanand D Naik Journal: BMJ Open Date: 2017-02-22 Impact factor: 2.692
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Authors: Max Bell; Lars I Eriksson; Tobias Svensson; Linn Hallqvist; Fredrik Granath; Jennifer Reilly; Paul S Myles Journal: EClinicalMedicine Date: 2019-04-27