Unplanned hospital readmissions are the subject of considerable public and government scrutiny, with more than 2,600 hospitals losing some reimbursement related to readmissions penalties in 2014 (see the October 8, 2014, HRC Alerts). However, according to the authors of a research letter in the March 11, 2015, JAMA, the causes of readmissions following hospitalization for sepsis are not well understood. The authors reviewed 2,843 Medicare claims for patients age 50 or older discharged following hospitalization for sepsis, of whom 1,115 (43%) were readmitted to the hospital within 90 days. Compared with a similar cohort of patients discharged following hospitalization for other acute medical conditions, the sepsis patients were readmitted more frequently. The most frequent causes for readmission were often related to conditions that could have been prevented with appropriate postdischarge ambulatory care, including heart failure, pneumonia, chronic obstructive pulmonary disease exacerbation, and urinary tract infection. Together, patients with these ambulatory care–sensitive conditions accounted for 42% of those readmitted following a sepsis hospitalization. The authors note that although they assumed that readmission for these conditions could have been prevented with appropriate ambulatory care, it is possible that they could not have been prevented, and they recommend further study to assess the feasibility and potential benefit of interventions tailored to patients' specific needs.

HRC Recommends: Patients recently discharged from hospitals may still be in a vulnerable state of health and are at risk of experiencing adverse events and preventable hospital readmissions without adequate and timely arranged postdischarge care. As the data analysis above indicates, consequences can extend beyond poor patient outcomes and include significant financial penalties for hospitals. Risk managers should ensure that a comprehensive discharge planning process is in place. A well-developed process can improve patient outcomes, reduce the likelihood that lengths of stay are inappropriately prolonged or shortened, reduce readmission rates, reduce incidences of repeated services, allow seamless services as patients transition from one level of care to another, support the appropriate use of intermediate care, promote collaboration with community services, and reduce costs.