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Editorials

Readmission rates

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7478 (Published 16 December 2013) Cite this as: BMJ 2013;347:f7478

Rapid Response:

Re: Readmission rates

Editor

Both the articles on re-admission in this edition of BMJ are based on a flawed premise. That is that re-admissions are somehow a marker of the quality of care within the acute hospital. Of course, there are instances where patients are sent home unwell and prematurely or with complications of hospitalisation. But for the most part, re-admissions occur either because:
1. The patient suffers a new illness unrelated to the first admission.
2. They have a long term condition such as cardiac failure or COPD which relapses.
3. The hospital, wanting to respect the patient's wishes to go home rightly accepts a degree of risk (its not as if remaining in a hospital bed is risk free after all).
4. Even carefully made plans for discharge are ignored, bypassed or subverted - by worried relatives, care staff etc.

The notion that somehow hospitals are responsible for the majority of re-admissions is a demonstrable falsehood and the way re-admissions are framed in the articles is a result of the US health insurance industry in which providers can be penalised for "never events" (which re-admissions can never be). They are in reality a feature of how well whole health and social care systems function, the quality of primary care an the help seeking behaviour of the public. But the US spends twice what the UK does as a proportion of GDP on health care, for lower life expectancy, lower equity, higher rates of preventable death, higher health inequality and worse continuity and access to primary care. So what these papers have to teach us is not clear

David Oliver

Competing interests: No competing interests

12 January 2014
David Oliver
consultant physician
royal berkshire nhs foundation trust
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