Intended for healthcare professionals


Readmission rates

BMJ 2013; 347 doi: (Published 16 December 2013) Cite this as: BMJ 2013;347:f7478

Re: Readmission rates

Drozda's editorial article on readmission rates is disappointing as there was no mention of the impact of mental health on readmissions, despite established evidence concerning the significant negative impact of co-morbid mental illnesses, such as depression, on morbidity and mortality outcomes in disease such as stroke and myocardial infarction1.

Although the studies were US based, the editorial article relates to the UK and fails to mention the large investment in liaison psychiatry services across the UK following the RAID trial in Birmingham, where it was demonstrated that good liaison psychiatry services reduce both length of admission and readmission rates substantially 2.

Two thirds of older people in acute hospitals are estimated to have delirium, depression or dementia so this is a key area of need. One example of how readmission rates can be reduced can be found at the current time in County Durham and Darlington, where the liaison psychiatry service offers short term follow up at home for such patients to ensure the discharge is sucessful and readmission is avoided.

Part of the problem is that hospital doctors did not, in the Donze paper, record mental health problems as comorbidities, despite the significant impact they have on the physical health of their patients. Unless medicine moves from the mind body dualism concept proposed by Descartes in the 16th centuary, towards an integrative concept of mental and physical health, patients will continue to suffer significant morbidity and mortality unnecessarily.

The editorial concludes with calling for 'additional insights of the type provided by Donze and colleagues to provide the right answers for our patients'. Those insights will not provide the 'right answers' if mental health is not addressed within them.

1.Meijer A, Conradi HJ, Bos EH, Anselmino M, Carney RM, Denollet J, Doyle F, Freedland KE, Grace SL, Hosseini SH, Lane DA, Pilote L, Parakh K, Rafanelli C, Sato H, Steeds RP, Welin C, de Jonge P. Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis.
Br J Psychiatry. 2013 Aug;203(2):90-102

2.George Tadros, Rafik A. Salama, Paul Kingston, Nageen Mustafa, Eliza Johnson, Rachel Pannell, and Mahnaz Hashmi. Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: the Birmingham RAID model. The Psychiatrist Online January 2013 37:4-10

Competing interests: No competing interests

17 January 2014
Philippa J Bolton
consultant psychiatrist
Chester-le-st health centre