Identifying Reasons for Readmission from the Epilepsy Monitoring Unit Compared to a General Neurology Hospital Service (P04.017)

Abstract

Objective: To identify reasons for 30-day readmissions from the epilepsy monitoring unit, compared to a general neurology hospital service. Background Reducing readmissions has become a national target for health care reform, but this assumes that a significant proportion of readmissions are preventable. Very little has been published on reasons for readmissions in neurological patients. Without such information it is unclear if readmission rates are an appropriate measure of quality of care in these patient populations. Design/Methods: Patients readmitted to our hospital from 4/1/2011 to 9/30/2011, with any diagnosis, and within 30 days of discharge from either the epilepsy monitoring unit or the general neurology hospital service, were included in this analysis. We retrospectively analyzed, via manual chart review, the electronic medical record to identify reasons for readmission. Reasons for readmissions were classified as planned vs. unplanned, expected recurrence/progression of underlying disease, unexpected recurrence/progression, hospital-acquired complication of index admission, and unrelated to index admission. Results: Sixty-two total readmissions were reviewed. Overall readmit rates were 6% for epilepsy, 7.3% for neurology. Rates for planned readmissions were 40% for epilepsy, 18.5% for neurology, with higher rates observed among epilepsy patients due to readmission for planned epilepsy surgery. Expected recurrence/progression was the primary reason for readmission in 23% of all epilepsy and 48% of all neurological readmissions. Hospital-acquired complications explained 23% of epilepsy, and 11% of neurology readmissions. The most common hospital-acquired complication was medication-related adverse events. Conclusions: Rates of planned readmissions ranged from 20-40%, a fact easily overlooked in national payment reform programs which treat nearly all readmissions, planned and unplanned, equally. Expected recurrence or progression of underlying disease was the most common cause for readmission in both epilepsy and general neurology patient populations. Identifying reasons for readmissions is an important initial step toward the ultimate goal of reducing the number of preventable readmissions. Disclosure: Dr. Bautista has nothing to disclose.