Identifying high-risk features for readmission in patient with metastatic solid tumor malignancies at an academic community hospital.

Abstract

217 Background: Readmission of oncology patients to hospitals is an undesirable outcome for both the patient and healthcare system. These can lead to delays in treatment and increased resource utilization. 30-day readmission have been a target of multiple national quality initiatives. Adverse outcomes have been associated with readmission in multiple patient populations. The aim of this study was to perform a qualitative and quantitative analysis on inpatient solid tumor medical oncology readmissions to an academic community hospital. Additionally, identifying additional risk factors for readmission such as need for fluid drainage and rate of palliative care involvement were assessed. Methods: Using ICD-10 codes, 183 patients were identified as being readmitted within 30 days with a known oncological diagnosis from January 2019-Decemember 2019. Only the most recent readmission was included for review. 54 of these patients were selected at random for manual chart review to generate data. Results: In the 54 patients who underwent detailed review, 21 were identified as having stage IV metastatic sold tumor disease primarily under the care of a medical oncology team. Common factors identified for readmission included malignant abdominal ascites (6 patients), thoracic pleural effusions requiring drainage (5 patients), CNS/spinal metastases (4 patients). Palliative care was consulted in the index admission in 48% of cases analyzed. In patients with metastatic solid tumor disease, 17/21 (81%) of patients were discharged on a weekday. Examples of preventable readmissions identified included inadequately treated hypercalcemia of malignancy and cerebral edema due to brain metastases discharged with insufficient corticosteroid dosing. Conclusions: The high-risk features identified (e.g. recurrent malignant ascites) may benefit from novel systems-based approaches (i.e. EMR alerts, daily oncology/palliative care team huddle to discuss high risk patients). Most patients readmitted to the oncology service with metastatic disease were not discharged on a weekend day. This analysis also revealed under-utilization of palliative care during the index admissions for these oncology patients with known metastatic disease. Further quality initiatives will be directed at creation of a risk score for readmission in this subset of patients with high disease burden.