Chamber and committees

28-Day Readmission Rate Following Discharge from a Surgical Specialty in a Scottish Hospital; 1999-2003

28-Day Readmission Rate Following Discharge from a Medical Specialty in a Scottish Hospital; 1999-2003

Notes:

1. These statistics are derived from data collected on discharges from non-obstetric and non-psychiatric hospitals (SMR01) in Scotland.

2. The basic unit of analysis for these figures is a continuous stay in hospital. Probability matching methods have been used to link together individual SMR01 hospital episodes for each patient, thereby creating “linked” patient histories. Within these patient histories, SMR01 episodes are grouped according to whether they form part of a continuous inpatient spell of treatment (whether or not this involves transfer between hospitals or even health boards).

3. Patients are counted as an emergency readmission if they are admitted as an emergency to any NHSScotland hospital for any diagnosis within 28 days of discharge from an index stay.

4. Cases are excluded where the patient has died in hospital or has died within 28 days of discharge.

5. Data for the calendar year 2003 is considered to be provisional.

6. The indicator presented adopts a conventional approach that relies on the statistical circumstance that the distribution of the interval to emergency readmission forms a distinct peak in the days immediately following discharge. Readmissions fall away thereafter to approach the background level of admission. This suggests that there is a strong probability that readmissions in the period following discharge are in fact related to that discharge. The period of 28 days is to some extent arbitrary, but it has been widely adopted as maximising the trade off between including as many related readmissions as possible and excludingas many unrelated readmissions as possible.

Over the past five years (1999-2003), there is no statistically significant difference* in the overall readmission rate, in Scotland, which is around 10% for medical specialties (e.g. cardiology, respiratory medicine etc) and around 5% for surgical specialties. (e.g. general surgery, orthopaedic surgery etc).

(*The rate for medical specialties has risen by 0.5% and that for surgical specialties has both risen and fallen by small amounts over the five-year period.)

For patients in the younger age groups ( 0 to 14 yrs and 15 to 24 yrs) readmissions in medical specialties show a slightly rising trend and this may be due to changes in the models of service where chronic disease, in children and young people, is increasingly treated in ambulatory centres and a child may have several short stays in hospital rather than one longer stay. This model of care is recommended by the Royal College of Paediatrics.

The figures include readmissions within 28 days whether or not the readmission was related to the previous hospital episode. The period of 28 days is to some extent arbitrary, but it has been widely adopted as maximising the trade off between including as many related readmissions as possible and excluding as many unrelated readmissions as possible.

Discharges and readmissions are matters for clinical judgement.

Patients aged 65 and over are likely to have a higher readmission rate than younger patients, but the rates for older people have remained stable over five years. Cases of chronic illness contribute significantly to readmissions for older people and hospital admission may be deemed appropriate where a more suitable service in the community is not available. A target has been set to reduce the numbers of elderly people admitted more than twice a year. Multi-disciplinary teams have been created to provide a rapid response in the community where that is more appropriate than hospital admission. The teams include, for example, nurses, physiotherapists and occupational therapists and local authority staff such as social workers.

“NHS Quality Improvement Scotland (QIS) : 2003 Clinical Outcomes Indicators Report”, available on the web, http://www.nhshealthquality.org/nhsqis/files/Clinical%20Outcome%20Indicators%20Report.pdf contains detailed information on a range of indicators including emergency readmissions to hospital following surgery.

Interpreting indicators such as readmission rates at hospital level is difficult, as any apparent variation may be due to a number of factors and no conclusions should immediately be drawn about quality/effectiveness of the services provided.

Although this is a reserved issue, the Scottish Executive liaises with officials in the Department for Work and Pensions regarding council tax benefit issues.

It would be for the police to investigate cases of physical assault reported to them. If such an assault is reported in a regulated care service, the Care Commission will consider what action to take, both during any police investigation and after it has been concluded.

The total numbers of complaints each year, by Care Commission regional office, were as follows: