Hospital readmission is a widely tracked metric in healthcare, signifying a patient returning to the hospital shortly after an initial discharge. This occurrence is a major focus for health systems because it measures care quality and drives substantial healthcare costs. When a patient is re-admitted, it suggests a failure in the initial treatment, the discharge process, or the post-discharge support. Evaluating these episodes allows providers to identify gaps in the patient care continuum.
Defining Hospital Readmission
A hospital readmission is formally defined as an admission to an acute care facility within 30 days of being discharged from an initial hospitalization (the index admission). This readmission may occur at the same hospital or a different one. Federal programs typically use an “all-cause” definition, meaning the reason for the second admission does not need to be related to the first illness. The standardized 30-day window reflects the period when initial care and immediate post-discharge support influence patient stability.
The industry primarily tracks unplanned readmissions, which signal potentially preventable complications or inadequate transitional care. Planned readmissions are excluded from quality metrics as they are medically necessary follow-up procedures, such as maintenance chemotherapy or pre-scheduled rehabilitation. Focusing on unplanned returns isolates issues related to the quality of care and discharge coordination.
Primary Factors Contributing to Readmission
Factors contributing to readmission are grouped into patient-related, clinical, and system-based categories. Patient-related factors often involve a lack of support or understanding after leaving the facility. For example, a patient may not grasp complex discharge instructions or struggle with adherence to a new medication regimen. Social determinants of health, such as poor social support, housing instability, or advanced age, also increase vulnerability in the post-discharge period.
Clinical and disease-related contributors involve the inherent complexity of the patient’s condition. Patients with multiple chronic co-morbidities, such as heart failure, COPD, or diabetes, face a higher risk of complications and disease exacerbation. Readmission may result from a complication of the original illness, such as a surgical site infection, or an unrelated health crisis.
System-level failures represent breakdowns in the care process that make the transition home unsafe. These include inadequate handover of care information between the hospital team and the patient’s primary care physician. Premature discharge, where a patient is released before their condition is fully stabilized or before therapy is completed, is another process failure that raises the risk of a swift return.
How Healthcare Systems Measure and Track Readmissions
Hospital readmission rates are a standardized national metric used to assess the quality and financial performance of healthcare institutions. In the United States, tracking is heavily influenced by the federal Hospital Readmissions Reduction Program (HRRP), which links performance to reimbursement. The HRRP focuses on six specific, common, and often preventable conditions or procedures, including heart failure, pneumonia, and elective hip or knee replacement.
Performance is measured by calculating an “excess readmission ratio,” which compares a hospital’s actual unplanned 30-day readmission rate to an expected rate for a similar patient population. Hospitals with a ratio higher than the national average may face financial accountability through reduced Medicare payments. This financial pressure, which can result in a reduction of up to three percent of base operating Medicare payments, incentivizes institutions to invest in better post-discharge support.
Strategies for Reducing Readmission Rates
Healthcare systems use strategies known as Transitional Care Management (TCM) to support patients during the vulnerable 30-day period after discharge. Comprehensive discharge planning is a core component, beginning early in the hospital stay to coordinate post-discharge care. This planning includes scheduling follow-up appointments with primary care providers before discharge and ensuring the receiving provider receives a timely summary of the hospital stay.
Medication reconciliation is a focused step where a qualified professional reviews the patient’s new prescriptions against their old ones to resolve discrepancies like omissions or incorrect dosages. This process is important because medication errors cause a large percentage of adverse events during care transitions. The goal is to ensure the patient fully understands what each medication is for and how to take it correctly.
Effective TCM programs involve active patient engagement and follow-up in the immediate post-discharge period. This often includes interactive contact with the patient or caregiver, such as a phone call, within two business days of discharge to check on their status. A required in-person follow-up visit with a physician within seven days allows for a timely clinical assessment and necessary adjustments to the treatment plan, lowering the risk of readmission.