Clinical question: What are the rates and the underlying risk factors for seven-day, unplanned, potentially preventable re-admission (PPR), among solid tumor patients in a medical oncology ward?
Background: The rate of unplanned 30-day readmissions at tertiary cancer centers has been estimated to be 22%, with a median time to readmission of nine to 10 days. Some studies have found that the frequency of PPRs is higher within seven days of discharge compared to those occurring between eight and 30 days post-discharge.
Study design: Retrospective cohort study
Setting: MD Anderson Cancer Center, Houston, Texas
Synopsis: The hospital medicine department at MD Anderson Cancer Center admits adult patients with solid tumors. This study was performed from September 1, 2020, to February 28, 2021. Readmissions were independently analyzed by two randomly assigned providers. Of 138 unplanned readmissions within seven days, 22 (15.9%) were deemed preventable. The median age was 62.5 years and 52.9% were female. The most common cancer type was non-colon GI, liver, or pancreatic cancer (34.06%), followed by colorectal and lung cancer. Most patients had stage 4 cancer (69.6%) and were discharged to home (64.9%).
The most commonly cited reasons for potential preventability were possible premature discharge, followed by missed opportunities for goals-of-care discussion, lack of one-week outpatient follow-up, and discharge medication errors. Reviewers attributed possible premature discharges to incomplete evaluation and management of medical problems and uncontrolled symptoms such as pain or recurrent ascites. Decreasing the 30-day readmission rate in cancer patients may be challenging due to new or worsening symptoms related to cancer progression or treatment. There may be more opportunities to prevent seven-day unplanned readmissions.
Bottom line: Premature discharge followed by missed opportunity for goals-of-care discussions were the most common reasons for potentially preventable seven-day readmissions.
Citation: Leung CK, et al. Understanding potentially preventable 7-day readmission rates in hospital medicine patients at a comprehensive cancer center. American College of Medical Quality 2024; 39(1):14-20.
Dr. Prystupa
Dr. Prystupa is a hospitalist in the division of hospital medicine at the Mount Sinai Health System and an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York. n