In Australia, rates of unplanned readmission within 28 days of hospital discharge are considered to be an indicator of healthcare quality and safety.
The Australian Commission on Safety and Quality in Healthcare define unplanned readmission:
“An avoidable hospital readmission occurs when a patient has been discharged from hospital (index admission) and has a subsequent unplanned admission that is related to the index admission and was potentially preventable.”
All Australian governments have committed to reforms under the National Health Reform Agreement Addendum, which include a focus on avoidable hospital readmissions.
A list of avoidable hospital readmissions has been developed by the Australian Commission on Safety and Quality in Health Care and approved by the Australian Health Ministers Advisory Council. The list includes readmissions for pressure injuries, infections, surgical complications, respiratory complications, venous thromboembolism, renal failure, gastrointestinal bleeding, medication complications, delirium, cardiac complications, constipation, nausea and vomiting.
In 2020–21, the Australian Institute of Health and Welfare reports rates of unplanned readmissions in public hospitals were highest for Tonsillectomy and adenoidectomy, Hysterectomy, and Prostatectomy. For hysterectomy, 31 per 1,000 hysterectomies resulted in unplanned readmission.
We know reducing avoidable hospital readmissions improves patient safety and health outcomes. Identifying the risk factors contributing to unplanned readmission is a key health priority. Certain patient characteristics, such as the age, comorbidities, poor functional status, and health literacy, are more likely to experience unplanned readmission. Other factors related to hospital readmission include high-volume hospitals and the patients access to primary care. In my experience, those with poor social support at home are also more likely to return to hospital.
Countries which have implemented financial incentives to reduce readmissions include the US, England and Germany. Australia does not have financial incentives to reduce readmissions, although the Independent Hospital Pricing Authority is exploring options. Although, the US have raised concerns about the usefulness and safety of their Hospital Readmission Reduction Programs, where hospitals are financially penalised if their readmission levels are higher than their benchmark rates. Each patient case can also be complex, and these penalties rely on pooled, retrospective data. While this data is big and impressive, it creates no meaningful insights as to how the health service could be improved. For example, if one hospital records a significantly higher “readmission to hospital” rate than the average, the administrative data will not be able to state whether this hospitals’ outcomes are problematic or not. The hospital could have i) poor performing surgeons, ii) be treating more high-risk patients, ii) performing more risky procedures that his/her colleagues aren’t willing to perform. In my opinion, penalising hospitals for a high number of unplanned hospital readmissions isn’t the way forward in Australia.
In addition, imposing a negative value on readmission contributes to the idea that someone is to blame. A study reported readmitted patients often felt that the hospital system contributed to their readmission, whereas health providers were more likely to identify patient factors as contributing to readmission. Such patient factors include the ASA score, parameters of general health (co-morbidity scores), age and body mass index rather than the hospital system or doctors. Surgical audit provides objective data to verify each scenario.
Instead, focusing on interventions to lower hospital readmission rates can include improving the care coordination, patient and carer education regarding self-management, surgical audit, improved discharge planning, and early follow-up.
Surgical Performance captures unplanned readmission to hospital, and the associated reason(s) for readmission. Gynaecologists can compare their readmission rates with their peers in trusted confidentiality.