Readmission within 30-Day as a Key Indicator for Academic Hospital Performance: Rate and Risk Factors

Background: Unplanned hospital readmission is concerning health care providers and is frequently used as a quality indicator for hospital care.&#x0D; Objectives: This study was conducted in order to examine the rate and associated factors for 30-day readmission in internal medicine units at King Abdulaziz University Hospital, Jeddah.&#x0D; Methods: We retrospectively collected data for patients who had readmission within 30 days of hospital discharge from January 2010 to December 2013. We obtained the following information for all patients: patient demographics, admitting medical service, diagnosis at the first admission, presence of hypoxia, sepsis, and hospital length of stay at the first admission. We then compared the data for patients with 30-day readmissions to those who did not have readmission within 30 days&#x0D; Results: Of the 3838 patients who had hospital admission within the study period, 678 (17.7%) had readmission within 30 days. The mean patient age was 52 years (SD, 21.2 years). Patients who had readmission within 30 days were more likely to be female; older than 65 years of age; diabetic; hypertensive; bed ridden; and to have a history of stroke, bed sores and/or sepsis (all P values ≤0.001, except for stroke, P=0.003).&#x0D; Conclusion: Our study showed that about 18% of patients had readmission within 30 days. Those patients were of older age, with comorbidities like, diabetes or stroke or were bedridden.</jats:p

The Challenge of Designing Key Performance Indicators for Academic Hospitals:

Background: This study assesses whether patients with ischemic heart disease receive comparable care and achieve similar outcomes compared to the rest of patients in the department of medicine at our tertiary academic center.&#x0D; Methods: This retrospective study examined the level of care received by all patients who were admitted to the Internal Medical Services at King Abdulaziz University Hospital from January 2010 through December 2012. A number of potential performance indicators were evaluated to ascertain level of care, including clinical deterioration with unplanned intensive care unit transfers, in-hospital complications, in-hospital mortality, and the rate of 30-day readmission. The t test or Mann-Whitney U-test was used to compare means and medians, respectively. The chi-square test was used to compare categorical variables.&#x0D; Results: Of 3838 patients, about a fifth of ischemic heart disease patients (19.3%) required intensive care unit transfer (P &lt; 0.001). Patients admitted through the emergency department were the largest group to require subsequent intensive care unit transfer (65.9% of all cases). The length of stay was significantly shorter in patients admitted to the cardiac care unit, compared with those admitted to other services (3.5 [1.5] days versus 5.8 [5.5] days for patients admitted to other units; P &lt; 0.001). Thirty-day readmission rate was significantly lower in ischemic heart disease patients (11.7%) compared with non- ischemic heart disease cases (18.5%) (P &lt; 0.0001).&#x0D;  &#x0D;  </jats:p

Designing Hospital Key Performance Indicators for Academic Centers: Measuring the Average Length of Stay

Background: Length of stay is an important performance indicator for hospital management and a key measure of health care efficiency. This paper aims to determine the average length of stay in our center and the factors that influence it. We also investigate whether our hospital's length of stay is a key performance measure that can be used to design quality improvement initiatives.&#x0D; Methods: We performed a retrospective analysis of hospitalizations at the Multi-disciplinary Internal Medicine Department of King Abdulaziz University Hospital, Jeddah between 2010 and 2013. We collected data including demographics, admitting diagnosis, admitting unit, treatments administered, and history of transfer from the Intensive Care Unit.&#x0D; Results: The mean length of stay was 5.9 (6.8) days. Patients admitted through the Emergency Department were more likely to have a longer hospital stay compared with those admitted through Day Care or the Outpatient Department (P &lt; 0.001). Expatriates (P &lt; 0.001), bedridden patients (P = 0.02), and those who received prophylaxis for deep venous thrombosis (P &lt; 0.001) were more likely to have a longer length of stay than the rest of the sample. Furthermore, patients admitted in the morning hours had a significantly shorter length of stay than those admitted in the evening hours (P &lt; 0.001).&#x0D; Conclusion: The length of stay among patients at our department is affected by hospital- or patient-specific factors. Health care can be improved by identifying and monitoring the length of stay in high-risk patients.&#x0D;  </jats:p

Determinants of Intensive Care Unit Transfer in Patients Admitted to the Medical Ward of an Academic Hospital in Jeddah

Objective:  This study aimed to identify the proportion of patients who had clinical deterioration in the medical ward that required intensive care unit transfer and the factors associated with this transfer.&#x0D; Methods:  A retrospective study of all patients admitted to the medical wards of King Abdulaziz University Hospital between 2010 and 2013 was performed.  The demographics, admitting department, diagnosis at the time of admission to the ward, and cause of intensive care unit transfer were collected.  Patients at risk for deterioration and early intensive care unit transfer were identified using physiologic threshold criteria.&#x0D; Results:  A screening of 38,380 patients admitted to the various medical services during the study period was performed.  Of these, 356 (0.9%) required intensive care unit transfer.  Most patients were initially admitted from the emergency department (66.3%), while transfers from another hospital comprised approximately 1%.  Intensive care unit transfer patients were more likely to have ischemic heart disease (P &lt; 0.001), diabetes (P &lt; 0.001), renal failure (P &lt; 0.001), or sepsis associated with pressure ulcers (P &lt; 0.001). They were also more likely to be bedridden (P &lt; 0.001) or initially ventilated in the medical ward (P &lt; 0.001).  The mortality rate of the patients was 3.9% with patients who died being more likely to have unstable blood pressure at the time of admission (P = 0.026).&#x0D; Conclusion: This study identified several factors that were associated with intensive care unit transfer.  Clinicians should consider these factors when determining patient disposition to ensure timely and appropriate management.</jats:p