20 CAUSES OF READMISSIONS FOR PATIENTS DISCHARGED ON ENTERAL NUTRITION

Abstract

Introduction Hospital readmissions adversely impact patients' quality of life and are costly. Interventions to avoid readmissions can reduce healthcare costs as well as improve patient outcomes. Patients discharged with enteral nutrition (EN) are noted to have increased hospital readmissions but data on the causes for readmissions are limited. We assessed the proportion of patients discharged with EN through an enteral access device (DCEN) readmitted for nutritional care and determined the contributing factors to readmissions. Methods Using electronic health record (EHR) data, we conducted a retrospective cohort study of all hospital encounters in a tertiary care, urban hospital from 7/2017 - 12/2019 with DCEN and unplanned readmission within 30-days. For each readmission, chart review was performed by a research assistant (AP) and physician (SP) to evaluate whether discharge documentation identified the primary cause of readmission to be complications of EN or gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) attributed to EN. For these EN-related readmissions, we collected the details of readmission cause, hospital course addressing the cause, and EN-related plan adjustments upon discharge. A secondary outcome was the number of days from initiation of EN to readmission. For non-EN related admissions, we evaluated for EN-related plan adjustments upon discharge to assess for secondary nutrition-related benefit from the readmission. Results Over the 30-month period, there were 224 encounters with DCEN and unplanned 30-day readmissions. 46 of 224 (20.54%) were identified as EN-related readmissions. 18/46 (39.1%) were related to symptoms the team attributed to EN, 20/46 (43.5%) documented enteral access device (EAD) issues, and 8/46 (17.4%) were due to sodium imbalance attributed to dehydration (Figure 1). The median number of days since initiating EN was 53 (IQR 21-145) and 29/46 (63.0%) were within 90 days of initiating EN. Of the 178 readmissions with a primary indication not related to EN, 58 (32.6%) involved a change to EN plan. Conclusion A significant proportion of patients discharged with EN have readmissions related to EN, especially within 90 days of initiating EN. The three most common causes, accounting for more than 80% of readmissions, were GI symptoms of intolerance, issues with the EAD, and sodium imbalance attributed to dehydration. A significant proportion of those with readmissions unrelated to EN have secondary nutrition-related benefit during the readmission. Quality improvement interventions targeting post-discharge care to address these causes may decrease hospital readmissions in this high-risk and medically complex population. Download : Download high-res image (65KB) Download : Download full-size image Pareto chart of causes for readmission. EAD: enteric access device. The line represents the cumulative total.