B.C. hospital readmission rate second-highest in Canada: report
Data an indicator of ‘sub-optimal health care system performance’
B.C. medical experts are calling for a concerted effort to improve hospital readmission rates, in the wake of a report showing the province had the second-highest such rate in Canada.
Hospital readmission rates have become a leading marker of healthsystem performance around the world. When they are relatively high, as in the case of B.C., they are an indicator of “sub-optimal health care system performance,” a recent report in the B.C. Medical Journal says. There are many risks to patients who return to hospital, not to mention higher costs to the health-care system.
In B.C., 9.6 per cent of discharged hospital patients end up returning in the next 30 days, often through emergency departments, because of complications from procedures or from infections, falls, blood clots, adverse drug reactions and pressure ulcers. The national average for unplanned hospital readmissions is 9.1 per cent. The province with the worst rate was Saskatchewan.
Readmitted patients have a threefold increase in dying within the year after discharge, relative to patients who remain at home after hospital discharge. Somewhere between 25 and 50 per cent of hospital readmissions are deemed, retrospectively, to be preventable but “reliably effective and focused interventions to prevent them remain elusive,” according to the B.C. Medical Journal report by internal medicine experts at the University of B.C. and Vancouver General Hospital.
In B.C., patients hospitalized for serious medical conditions like mental health issues, incurable diseases like cancer, heart failure and chronic obstructive pulmonary disease (COPD) are most likely to be readmitted (15 per cent), followed by surgical patients (eight per cent), and children under age 19 (seven per cent). Only two per cent of maternity patients are readmitted within a month after discharge.
“Patients are often vulnerable and frail when they are discharged from the hospital,” said Dr. John Staples, a Vancouver internal medicine specialist who co-authored the journal’s report on readmissions.
Staples said patients who seem to return most often are men, seniors, those with multiple diseases, poor people and those who have been in and out of hospital over the previous six months. In the current Quality Management in Healthcare journal, Staples and his co-authors show that in a Vancouver General Hospital patient group, the most common causes of preventable readmissions were inadequate co-ordination of community services upon discharge, poor clinical post-discharge followup and suboptimal end-of-life care.
Staples said there’s no sciencebased answer as to why men are more likely than women to be readmitted. “But I could take a few guesses. Men are less likely to adhere to their recommended treatment and they seem to be more cavalier about health conditions like COPD.”
Physicians do their best to “set patients up for success” upon hospital discharge, but returning to hospital is more likely when patients have complex medical issues. Staples said that to minimize the risk of being readmitted, patients and their family members should ensure they’re handed a discharge report summarizing the diagnosis, treatment and further recommendations for followup care. If it’s not ready upon discharge, patients should go back and get it when it’s ready. They should also see their primary care provider after discharge and have a plan for home care or other required community services, said Staples, who works at both St. Paul’s Hospital and Vancouver General.
Staples said patients should also keep on hand their discharge summary from their last hospitalization and a list of medications so that if they return to the hospital, especially if it’s a different one, they can share that information with the next medical team.
The B.C. Medical Journal report shows that many of the hospitals with higher readmissions are small and in rural or remote areas; in Bella Coola, it is 16 per cent and in McBride it is 18 per cent. There are exceptions, such as Port McNeill, which has an impressively low readmission rate: just four per cent.
Staples said small hospitals face unique challenges, like few medical specialists.
In one experiment underway across B.C., hundreds of congestive heart failure patients are being supplied for two months with tele-monitoring equipment that collects biometric measurements.
The TEC4Home study aims to show whether unnecessary emergency department visits can be reduced when newly discharged patients take daily readings of their blood pressure, weight and oxygen saturation levels that are then shared with nurses who review the data and liaise with doctors to determine if medication changes are needed.
Jane Grafton, a Surrey resident who took part in the trial when it began last year, said she’s been hospitalized six times in the past four years but after the last stay, she was enrolled in the trial. Using the digital instruments provided to her was an eye-opening experience.
“It was brilliant because it helped me see what was happening. I could control my fluids, the food I was eating, and my weight,” said the 74-year old Grafton who, in addition to heart failure, has COPD and diabetes.
The TEC4Home trial is an example of a “thoughtful” telemonitoring trial exploring innovations that may help reduce hospital readmissions, but a concerted effort is required by doctors, hospital administrators and government to wrestle with the problem, Staples said.
It was brilliant because it helped me see what was happening. I could control my fluids, the food I was eating, and my weight.