Cutting Hospital Readmissions Requires Reducing Complications

September 2012

According to "Risk factors for 30-day hospital readmission among general surgery patients," a study in the September 2012 issue of Journal of the American College of Surgeons, complications after surgery are the most significant risk factors that send general surgery patients back to the hospital within 30 days of discharge. Dr. John Sweeney, director of clinical quality and patient safety and chief of the division of general and gastrointestinal surgery, Emory Department of Surgery, was the senior author of the study, and James C. Cox, director of the Experimental Economics Center of Georgia State University, was one of the co-authors. This is the first phase in a larger collaborative study on discharge decisions being undertaken by Dr. Sweeney and Dr. Cox's collaborating teams.

Using standard National Surgical Quality Improvement Project protocol, the investigators analyzed records of 1,442 general surgery patients at Emory University Hospital (EUH) between October 2009 and July 2011. Of the sample, 163 patients, or 11.3 percent, were readmitted within 30 days of discharge. The study identified three primary causes of readmission: pre-existing conditions, complications developed in the hospital, and complications developed post-discharge. Nearly half of readmissions were due to gastrointestinal complications and surgical infections. The top surgical complications were pulmonary complications and wound and urinary tract infections.

"Decreasing complications will benefit the patient, the hospital and the payer, and will improve quality of care," said Dr. Sweeney. "Steps can be taken and protocols established that will minimize postoperative complications. For example, at EUH we have just embarked on a pilot protocol to standardize the use and monitoring of indwelling urinary catheters, which account for 80% of nosocomial urinary tract infections."

Hospitals face increasing pressure to reduce readmissions and will see reduced Medicare payments for excessive readmissions under the Affordable Care Act. The penalty will be calculated by comparing a hospital's readmission rate of certain kinds of patients to national averages.

The current stage of research in this ongoing study entails further collaboration with experts in decision-making at GSU's Experimental Economics Center to develop decision support software that will help improve outcomes. Laboratory experiments have already been completed testing the decision support software and the data is being analyzed before another round of testing. The final stage in this research process will be to roll the decision-making software out onto the patient wards.