Studies find correlation between busy hospitals and higher readmission rates

According to two recent studies conducted by several researchers at the University of Maryland’s Robert H. Smith School of Business, there is a correlation between hospital readmission rates and how full the hospital was at the time of discharge. This suggests that many patients went home earlier than they should have.

“The main point is that the discharge rate goes up as the beds begin to fill up, which is what you’d expect to a certain degree,” said David Anderson, co-author and researcher for the studies. “First reason is if you have extra beds available, people stay an extra night as a precautionary measure. If beds are in high demand, you might send people home earlier than you may have if there were extra beds. Many patients may have not been ready to go home, however, it’s not done on purpose – the patients who were sent home appeared to be healthy.”

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"Patient traffic jams present hospitals and medical teams with major, practical concerns, but they can find better answers than sending the patient home at the earliest possible moment," said Bruce Golden, University of Maryland Professor and one of the researchers for the studies, in a press release.

In the studies, Golden and Anderson tracked patient movement at a large, academic medical center located in the United States, said Anderson.

They found that patients discharged when the hospital was busiest were 50 percent more likely to return for treatment within three days. This indicates recovery was incomplete when patients were first released, he said. The study tracks occupancy rates, day of the week, staffing levels and surgical volume.

[Also: Readmission costs even higher than suspected]

Surgeons and hospitals are incentive-driven to perform as many surgical procedures as feasible, Golden said in a written statement.

"The hospital has to maintain revenue levels to meet its financial obligations. Surgeons are working to save lives and earn a livelihood. It's what they do," he said in a press release. "If the hospital says 'sorry there are no beds available,' there's a lot of tension and pressure from both sides to keep things moving."

These problems are much more likely at large hospitals, which tend to provide more advanced, specialized surgeries not accessible at smaller, community institutions, said Anderson. Patients often have to travel a great distance for the procedures, so hospital delays become expensive for both them and the care providers.

The study findings cover surgical discharge data from fiscal year 2007 and encompass more than 7,800 surgery patients who collectively spent 35,500 nights at the facility.

"This gives us a good snapshot of the pressures at work in a busy non-profit hospital," Golden said in a press release. "Other institutions may handle the challenges somewhat differently, but the pressures are widespread and these results call for some introspection."

Anderson said he and his team of researchers have several recommendations to help hospitals combat the problem.

Golden suggests that surgeons use checklists before discharging the patient. "They know better than we do what questions should be asked - questions that would force the surgeon to think about whether they were discharging the patient for the right reason," he said in a written statement.

Anderson suggests that hospitals increase the flexibility of where patients go post-surgery. Allowing them to be moved to units with empty beds, for example, could also lessen premature discharges.

Though, this may increase costs in the short run, discharging patients who then quickly return to the hospital offers no long-term savings, and decreases the quality of care, he said.

“If hospitals can work on increasing flexibility, it could help the problem,” said Anderson.

Both studies appear in the two most recent issues of the peer-reviewed journal, Health Care Management Science.

[Also: Hospital readmission rate tied closely to overall hospital admissions]