Introduction and Objective Early readmission of patients with COPD is responsible for significant healthcare costs. To minimise this, DoH has proposed financial penalties to Trusts for readmissions within 30 days of discharge1. Previous studies have questioned this proposal’s justification2. We conducted this study to examine this issue in our Trust.
Methods List of patients with primary diagnosis of COPD readmitted within 30 days of discharge in 2011 was obtained from clinical coding department and was further scrutinised to identify patients in whom this diagnosis was correct. Available notes were reviewed and data was collected using a locally designed pro-forma.
Results From initial list of 361 episodes, 47 patients were readmitted over 53 episodes of which 25 were truly for exacerbation of COPD. Patient’s characteristics are described in Table. Readmission occurred even if patients were on maximum/optimum treatment (96%) and had respiratory input (84%). Only 3 episodes (12%) required ventilator support (invasive/ non-invasive) that could not have been managed outside hospital. The average length of stay was 8.12 days.
Conclusions and Discussion The best medical care during initial admission does not reduce readmission. Factors associated with readmission are largely unmodifiable by medical intervention and beyond control of healthcare professionals and Trusts. Admission avoidance schemes are not available widely; and may be answer to the problem by reducing rate of admission through various supportive and non-medical measures made available in the community. Incentive for lower readmission rates rather than penalty for higher readmission may encourage Trusts to invest in admission avoidance services. The bed cost alone would be £53,592 for 22 avoidable admissions with hospital stay of 8.12 days @£300/day. Non-payment for readmissions would amount to a loss of £87,079 on minimum tariff of £1643/patient. 53% of this would have been for wrongly coded patients; and may be a matter of interest for managers.
“The Operating framework for the NHS in England 2011–12”–by Department of Health - page 52, paragraph–5.33.
J Hare et al. 30-Day COPD readmissions relate to disease severity and demographic factors rather than simply organisation and delivery of hospital care. Thorax 2011;66:Suppl 4 A107-A108.
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