Inpatient Unit Heart Failure Discharge Volume Predicts All-cause 30-Day Hospital Readmission

Dzifa Dordunoo, Sue A. Thomas, Erika Friedmann, Stuart D. Russell, Robin Newhouse, Bim Akintade

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND:: All-cause 30-day hospital readmission is a heart failure (HF) quality of care metric. Readmission costs the healthcare system $30.7 million annually. Specific structure, process, or patient factors that predispose patients to readmission are unclear. OBJECTIVE:: The aim of this study is to determine whether the addition of unit-level structural factors (attending medical service, patient-to-nurse ratio, and unit HF volume) predicts readmission beyond patient factors. METHODS:: A retrospective chart review of 425 patients who resided in Maryland and were discharged home in 2011 with the primary diagnosis of HF from a large, urban academic center was conducted. RESULTS:: The patients were predominately (66.6%) black/African American, with mean (SD) age of 62.2 (14.8) years. Men represented 48.2% of the sample; 32% had nonischemic HF, 31.3% had preserved ejection fractions, 25.4% had implantable cardioverter defibrillators, and 15.3% had permanent pacemakers. Average length of stay was 6.0 days. All-cause 30-day hospital readmission rate was 20.2%. Inpatient unit HF discharge volume significantly predicted readmission after controlling for patient factors. CONCLUSIONS:: The study found that discharge from inpatient units with higher HF discharge volume was associated with increased risk of readmission. The findings suggest that in caring for patients with severe HF, inpatient unit HF discharge volume may negatively impact care processes, increasing the odds of hospital readmission. It is unclear what specific care processes are responsible. The discharge period is a vulnerable point in care transition that warrants further investigation.

Original languageEnglish (US)
JournalJournal of Cardiovascular Nursing
DOIs
StateAccepted/In press - Mar 29 2016

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Patient Readmission
Inpatients
Heart Failure
Point-of-Care Systems
Patient Transfer
Cardiac Volume
Implantable Defibrillators
Quality of Health Care
African Americans
Length of Stay
Nurses
Delivery of Health Care
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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Inpatient Unit Heart Failure Discharge Volume Predicts All-cause 30-Day Hospital Readmission. / Dordunoo, Dzifa; Thomas, Sue A.; Friedmann, Erika; Russell, Stuart D.; Newhouse, Robin; Akintade, Bim.

In: Journal of Cardiovascular Nursing, 29.03.2016.

Research output: Contribution to journalArticle

Dordunoo, Dzifa ; Thomas, Sue A. ; Friedmann, Erika ; Russell, Stuart D. ; Newhouse, Robin ; Akintade, Bim. / Inpatient Unit Heart Failure Discharge Volume Predicts All-cause 30-Day Hospital Readmission. In: Journal of Cardiovascular Nursing. 2016.
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abstract = "BACKGROUND:: All-cause 30-day hospital readmission is a heart failure (HF) quality of care metric. Readmission costs the healthcare system $30.7 million annually. Specific structure, process, or patient factors that predispose patients to readmission are unclear. OBJECTIVE:: The aim of this study is to determine whether the addition of unit-level structural factors (attending medical service, patient-to-nurse ratio, and unit HF volume) predicts readmission beyond patient factors. METHODS:: A retrospective chart review of 425 patients who resided in Maryland and were discharged home in 2011 with the primary diagnosis of HF from a large, urban academic center was conducted. RESULTS:: The patients were predominately (66.6{\%}) black/African American, with mean (SD) age of 62.2 (14.8) years. Men represented 48.2{\%} of the sample; 32{\%} had nonischemic HF, 31.3{\%} had preserved ejection fractions, 25.4{\%} had implantable cardioverter defibrillators, and 15.3{\%} had permanent pacemakers. Average length of stay was 6.0 days. All-cause 30-day hospital readmission rate was 20.2{\%}. Inpatient unit HF discharge volume significantly predicted readmission after controlling for patient factors. CONCLUSIONS:: The study found that discharge from inpatient units with higher HF discharge volume was associated with increased risk of readmission. The findings suggest that in caring for patients with severe HF, inpatient unit HF discharge volume may negatively impact care processes, increasing the odds of hospital readmission. It is unclear what specific care processes are responsible. The discharge period is a vulnerable point in care transition that warrants further investigation.",
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