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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

Re: Readmission rates

Using readmission as a marker of discharge failure shows unidimensional thought typical of many 'measurements' of quality.

Discharge from hospital should occur when the risks of being in the community (usually exaggerated) are less than those of remaining in hosopital (Usually ignored) and/or the benefits of discharge (often ignored) are greater than the benefits of remaining in hospital (usually overrated). As with all judgements, there is going to be some error.

If readmission becomes yet another stick to beat the medical profession with, and every readmission considered a failure, then doctors will 'play safe.' The obvious way to reduce the readmission rate is by increasing the length of stay. The hospital induced morbidity and negative effects on patients and families of this consequence will remain unmeasured.

I contest that a hospital with no readmissions is needlessy delaying discharge of a large number of patients. It seems sensible to ascertain what figure reflects a suitable balance for these conflicting requirements, likely to be a few percent of all admissions. Having readmission rates above, or equally importantly below, the expected level should precipitate a review of practice.

Competing interests: No competing interests

13 January 2014
Anthony Cohn
Paediatrician
West Herts Hospital
Vicarage Road WD18 0HB