Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
This is a valuable contribution to the debate regarding readmission rates.
It is not widely appreciated that the average US hospital is very small and hence is unable to gain economy of scale (1-5).
Average costs are therefore higher and Medicare DRG remuneration can create cost pressures. Early and inappropriate discharge is an attempt to contain costs and results in lower average length of stay in smaller US hospitals (6).
It would be useful if the authors could re-examine their data to see if hospital size plays any role in readmission rates.
1. Jones R (2011) Hospital bed occupancy demystified and why hospitals of different size and complexity must operate at different average occupancy.British Journal of Healthcare Management 17(6): 242-248.
2. Jones R (2011) A&E performance and inpatient bed occupancy. British Journal of Healthcare Management 17(6): 256-257
3. Jones R (2012) A simple guide to a complex problem – maternity bed occupancy. British Journal of Midwifery 20(5): 351-357.
4. Jones R (2013) A guide to maternity costs – why smaller units have higher costs. British Journal of Midwifery 21(1): 54-59.