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An audit on short term readmission at the medeor institute of emergency medicine

Author: 
Dr. Dolly C Yadav, Dr. VGR Shastry and Dr. Tamorish Kole
Subject Area: 
Health Sciences
Abstract: 

Emergency departments (ED) care for patients with a diversity of requirements that decide their disposition and revisit to the ED. Furthermore, readmissions to the hospital are often used as a quality indicator. However, caution must used since readmissions are complex in nature and only the avoidable readmission need to be dealt with improvements. Thus, we undertook an audit at the Medeor Institute of Emergency Department (MIEM) to gauge the readmissions within 72 hours. Therefore, all patients presenting to the ED within 72 hours of their admission to the hospital were prospectively included from June through September 2019. Each of these patients were further categorized hierarchically and exclusively into 5 categories as: (I) Avoidable readmissions – (IA) readmissions due to inadequate care/misdiagnosis, (IB) readmission due to poorly managed transitions during discharges; (II) Unavoidable readmission – (IIA) readmissions due to complication/disease progression, (IIB) readmission due to recurrence of symptoms; (III) Unrelated readmission (different organ system involvement); (IV) Readmission due to planned procedure or admission; and (V) Readmission after leaving against medical advice (LAMA). This categorization was based on our earlier study2. It was observed that the short term readmission rate at MIEM was 0.48%. A fifth of these readmissions were avoidable. Moreover, one (6.7%) patient returned to the ED due to poorly managed transitions during discharges due to poor understanding of instruction to return to ED, while two (13.3%) patients received inadequate care as a result of misdiagnosis. Hence, ED discharge summary with written discharge instructions, in addition to verbal explanation, and mandatory co-signature of every ED initial assessment by Emergency Consultant are introduced to address these lacunae.

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