COMMENTARY

No Return Trips: Hospitals Under Pressure to Lower Readmissions

Shmuel Shoham, MD

Disclosures

April 23, 2015

In This Article

Infection and Readmission

Major investment in shoring up the linkages between inpatient and outpatient care and providing a "soft landing" for discharged patients is necessary. Spurred by the demands of insurers (especially Medicare), resources are being shifted in this direction. But hospital administrators alone will not solve this problem. It is a system-wide challenge that will require system-wide solutions. Experts in prevention and treatment of infections have an important role to play in providing and refining those solutions.

Infections are a major reason for patients to be in the hospital in the first place. An infection can trigger decompensation of chronic conditions (such as asthma, COPD, or CHF), serve as the primary cause of admission (for pneumonia, cellulitis, or pyelonephritis), or complicate an existing hospitalization (with ventilator-associated pneumonia, catheter-associated urinary tract or bloodstream infections, or surgical-site infections). In 2010, the top 5 reasons for hospitalizations in the United States (in descending order) were[2]:

Infections are also a major cause of rehospitalization.[3] For Medicare patients who are admitted to hospital with pneumonia, the most common cause of readmission is also pneumonia. This is not a surprise. The original infection may have recrudesced, or the predisposing conditions could have persisted or intensified. However, pneumonia and septicemia are among the top causes for readmission even in patients whose original hospitalization was for something completely different, such as CHF or AMI.[3] Infections are a leading reason for readmission in conditions as diverse as cancer, vascular surgery, and liver transplantation. All of these points toward a heightened period of vulnerability to serious illnesses, including infections, in the period after discharge from hospital.

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