Intended for healthcare professionals

Student Research explained

Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study

BMJ 2014; 348 doi: (Published 05 March 2014) Cite this as: BMJ 2014;348:g1667
  1. Neil Chanchlani, foundation year 1 doctor1,
  2. Erin Russell, assistant editor2
  1. 1Whipps Cross University Hospital, London, UK
  2. 2Canadian Medical Association Journal, Ottawa, ON, Canada

The paper

  • “Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study” by Jacques Donzé and colleagues. (BMJ 2013;347:f7171, doi:10.1136/bmj.f7171).

Why do the study?

Work in emergency medicine or medical/surgical assessment can often yield interesting days. Patients come to hospital for various reasons; some present because they are acutely unwell, some present with exacerbations of chronic illnesses, and others present because they require social and multidisciplinary input into their care and home environments.

For a junior on the “frontline,” perhaps the most gut-wrenching moment is when you’re asked to see a patient who you’ve recently discharged from your care. You wonder whether you made a mistake in prescribing or if you discharged them too early. Then begins the attempt to diagnose the patient and, rather defensively, to find out whose fault it is that they’ve re-presented to hospital.

We know that about a fifth of patients who are discharged from hospital bounce back into hospital via GP referral or re-present through the emergency department within 30 days after discharge.1 Reasons for readmission include adverse drug events, avoidable infection, complications of procedures and treatments, and preventable acute exacerbations of chronic illnesses.

The authors of this study wanted to ascertain why patients get readmitted and offer solutions as to how we can reduce the numbers. They hypothesised that patients’ comorbidities could play an important role. Comorbidities can be defined as the simultaneous coexistence of more than one health condition in a single individual—for example, someone who has chronic obstructive pulmonary disease (COPD) and insulin dependent diabetes is said to have both comorbidities.1

There is already evidence to suggest that a patient’s primary diagnosis on readmission (within 30 days) differs from the primary diagnosis responsible for the index—or original—admission, suggesting that there must be other factors at play. Additionally, studies have suggested …

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