Study examines who is returning and why

Download the report: All-Cause Readmission to Acute Care and Return to the Emergency Department

June 14, 2012—Soon after their discharge from hospital, more than 180,000 Canadians were readmitted to acute care in 2010, reveals a study from the Canadian Institute for Health Information (CIHI). In those jurisdictions where detailed emergency department (ED) data was available—Alberta, Ontario and Yukon—nearly 1 in 10 acute care patients returned to the ED within seven days of hospital discharge. The study, All-Cause Readmission to Acute Care and Return to the Emergency Department, included more than 2.1 million hospitalizations across the country. It looked at surgical, medical, pediatric and obstetric patients to better understand who returned to acute care after discharge and for what clinical reason.

“Better understanding of the factors influencing readmission rates is an important step for improving the quality of care for Canadians,” says Jeremy Veillard, Vice President of Research and Analysis at CIHI. “Although readmissions cannot always be avoided, research suggests that in many cases they may be prevented.”

Reasons for readmission varied by patient group

• Medical patients were most likely to be readmitted for chronic obstructive pulmonary disease and heart failure—more than two in five of these readmitted patients returned to hospital for the same condition.
• The highest volume of readmission among pediatric patients was for respiratory infection and pneumonia, while pediatric patients who were originally hospitalized for chemotherapy or radiotherapy had the highest readmission rates.

• Nearly 1 in 10 (9.3%) readmitted surgical patients—more than 4,000 patients—returned to hospital for infections following a procedure.
• Close to one in four patients readmitted following a Caesarean section returned because of an obstetric or surgical wound infection.

“Returning to the emergency department shortly after discharge, or being unexpectedly readmitted, can be very stressful for patients and families,” explains Dr. Irfan Dhalla, staff physician and scientist at St. Michael’s Hospital in Toronto. “Understanding who is returning to hospital and why can help identify strategies to reduce readmissions and improve care for patients.”

Length of initial stay in hospital predicted readmission

The study found that both very long and very short patient lengths of stay (that is, those that deviated from the expected length of stay) were predictors of readmission.

Additional predictors of readmission included neighbourhood income and place of residence: patients from lower-income neighbourhoods and those from rural areas had a higher risk of readmission.

Other factors associated with higher readmission rates for medical and surgical patients included the patient’s age and the number of other existing conditions that he or she had. Gender also played a role—male patients were slightly more likely than female patients to return to the ED within seven days of their initial discharge.

Media contacts: media@cihi.ca

• Figure 1: Distribution of Triage Levels for Patients Returning to the ED Within Seven Days, Compared With All ED Patients (Figure 8 in the report)
• Figure 2: Rate of Inpatient Readmissions by Urban/Rural Residence, Overall and by Patient Group (Figure 3 in the report)
• Table 1: Rate of Inpatient Readmissions, by Income Quintile and by Patient Group (Percentage) (Table 6 in the report)

Established in 1994, CIHI is an independent, not-for-profit corporation that provides essential information on Canada’s health system and the health of Canadians. Funded by federal, provincial and territorial governments, CIHI is guided by a Board of Directors made up of health leaders across the country. Our vision is to improve Canada’s health system and the well-being of Canadians by being a leading source of unbiased, credible and comparable information that will enable health leaders to make better-informed decisions.