Reasons for readmissions from Geriatric Evaluation and Management in the Home(GITH) to an acute care setting in a regional sub-acute service of Victoria, Australia.

Abstract

Aim: To describe nature of readmissions in a newly implemented bed-substitution program, Geriatric Evaluation and Management in the Home (GITH) to an acute care setting. Method: Retrospective medical record audit of consecutive patients discharged from GITH after commencement in Sep 2013 to Jan 2014. Reason for an unplanned readmission was a consensus decision by GITH staff. Results: In 5 months, 41 patients were discharged with 11 unplanned readmissions (27%) most (10/11, 91%) returned within 30 days. Readmitted patients were 78 years (mean), male (n = 9, 82%), with cognitive impairment (n = 7, 65%) and lived alone (n = 6, 55%). There was discordance between the patient and the sub-acute inpatient clinical team about timing and/or desirability of discharge home onto GITH (n = 5, 45%). Reasons for unplanned readmission: an exacerbation or complication of admission diagnosis (n = 6), an unexpected change in a known comorbidity (n = 4) and a new event (n = 1). The nature of care received on readmission was: diagnostic (n = 4, 36%), clinical management (n = 5, 45%) and combined (n = 2, 18%). The person initiating readmission was GITH staff (n = 4, 36%), patient/family (n = 3, 27%) and other (n = 4, 36%). GITH could have provided the additional care for one readmitted patient (9%). Conclusions: Unplanned readmissions of GITH patients to acute appear unavoidable once on the program. Patients at higher risk were those wanting to leave hospital earlier than considered desirable by the inpatient team.