Abstract
Introduction
The Department of Health determined that, from April 2011, Trusts would not be paid for emergency readmissions within 30 days of discharge. The purpose of our project was to identify factors associated with such readmissions and implement plans for improvement.
Methods
A literature search was performed to assess current practice. The case notes of all readmissions were then obtained and analysed. Following consultation on the results, procedures were developed and implemented to ensure that readmissions were correctly defined and avoided where appropriate. The orthopaedic department infrastructure was altered and staff briefed and trained to accommodate the changes.
Results
Between January 2004 and December 2010, 4886 patients were treated under a single orthopaedic firm. 143 of these were classified as emergency readmissions. Pre-operatively, peri-operatively and post-operatively, no predominant features were identified from casenote analysis. 59 (46%) were elective cases. The average length of initial stay was 4.2 days, length between discharge and readmission 12.8 days and length of stay on readmission 5.8 days. There were no mortalities.
Only 10% of the readmissions actually warranted emergency hospital treatment. 52% required assessment and 38% were planned readmissions. The readmissions requiring assessment were found to share common features. This led us to develop and implement treatment and management protocols standardising the management of all potential readmissions whilst improving communication and coordination between the accident and emergency and orthopaedic departments as well as between patients and community services.
Discussion
Through the use of clear treatment and management protocols the department is now equipped to avoid inappropriate readmissions. The authors feel that this study highlights an issue faced by all orthopaedic departments across the UK and should help Trusts develop their own local guidelines to reduce readmissions, save on costs and improve patient care.
