Abstract Details

Title Early Inpatient Readmissions of Acute Care Neurology Patients to Higher Level of Care Units: Opportunity for Quality Improvement in Transitions of Care

Topic Practice, Policy, and Ethics

Presentation(s) S22 - Practice, Policy, and Ethics: Improving Patient Care and the Rise of Telemedicine (4:06 PM-4:18 PM)

Poster/Presentation
Number 004

Objective To evaluate acute care neurology patient characteristics and system factors associated with early readmission (< 72 hours) to the neurocritical care unit (NCCU) and intermediate stepdown care unit (ISCU) following transfer to lower level of care units at an academic hospital.

Background Early readmissions after transfer from higher to lower level of care units are associated with increased resource utilization and may be an indicator of care quality. Little is known about in-hospital readmissions of acute care neurology patients.

Design/Methods We performed a retrospective analysis of acute care neurology patients readmitted to higher level of care units (NCCU or ISCU) within 72 hours of transfer to a lower level of care unit between January 2015 and May 2017. Data collected included readmissions during “off hours” (weekend or overnight), critical care interventions administered within 2 days prior to transfer, and primary readmission reason.

Results 92 readmission events occurred in 90 patients. Average time to readmission was 29.5 hours (24% ≤12 hours; 26% >12 to ≤24 hours; 50% >24 to ≤72 hours). Most readmissions occurred during “off hours” (27% weekend; 43% overnight). Primary readmission reasons included: respiratory distress (44%), neurological status decline (25%), hemodynamic instability (9%), sepsis (5%), MI (2%), cardiac arrest (1%) and other (14%). 44% of readmitted patients were diagnosed with a comorbidity (infection, seizure, cardiopulmonary complication, renal failure/insufficiency) during their index higher level of care stay; 74% received a critical care intervention within 2 days prior to transfer. Average length of stay in the higher level of care unit after readmission was 142 hours (SD + 147 hours).

Conclusions The majority of readmissions occurred during “off hours.” Respiratory distress and declining neurological status accounted for most readmissions. Quality improvement interventions targeting transfers during “off hours” and focused on early detection of respiratory and neurological decline may be effective in preventing readmissions.

Authors/Disclosures
Amanda M. Crooks, MD (UNC) PRESENTER	No disclosure on file
Casey Olm-Shipman, MD (UNC School of Medicine)	Dr. Olm-Shipman has nothing to disclose.

��ɫ��

��ɫ��