Precipitating factors and avoidability of 7-day readmissions after hospitalization for heart failure

BackgroundHospital readmissions within 7 days after discharge are considered highly avoidable and undesirable for the patient and hospital. It is important to clarify gaps in the quality of inpatient care to identify strategies to address this problem. AimsWe aimed to describe the precipitating factors and determine the potential avoidability of 7-day readmissions after hospitalization for heart failure (HF). MethodsA health record audit was undertaken of patients discharged after hospitalization for HF from Calgary, Alberta hospitals. Content analysis was undertaken to identify factors precipitating readmission, and readmissions avoidability was qualitatively examined and scored based on descriptive categories. ResultsOf 18,590 patients admitted to the hospital for HF during the study period, 191 HF patients were readmitted within 7 days (50% female; mean age 78 years). Potentially avoidable readmissions (57%) were due to unresolved symptoms, unaddressed social or self-care issues, adverse events from the index admission, high disability without added services, and discussions of palliative care without added services. Readmissions deemed less avoidable (43%) were due to new health issues, recurring symptoms post-stability at discharge, or refusal of care. ConclusionOnly half of hospital readmissions within 7 days after HF discharge were related to HF and more than half were scored as avoidable. We provide novel criteria for identifying the avoidability of 7-day readmissions that could be used for assessing HF patients readiness for discharge and potentially reducing readmission rates.