​Shorter initial hospital stays may result in an increased risk of readmission to hospitals from postacute care (PAC) facilities among older or frail patients, according to a clinical investigation published in the February 2017 issue of the Journal of the American Geriatrics Society. The authors conducted a secondary analysis of 81,173 patients age 65 or older who were readmitted from a PAC facility within 30 days of initial discharge from hospitals in California, Florida, and Massachusetts. More than a quarter of the readmissions (21,399 or 26%) occurred within the first seven days. These patients tended to be older, white, live in urban areas, and have fewer comorbid illnesses. The study found a strong association between a shorter initial stay and seven-day readmission. For every additional initial day in the hospital, the likelihood of readmission decreased by 2%, the authors said. After the first week, readmissions tended to be associated with increased disease burden and thus "may be associated with factors that are less modifiable," the authors said. The study was the first to look at the association between timing of hospital readmission and length of initial stay among patients discharged to PAC facilities, the authors said. The results may "support the theory that patients may be discharged 'quicker and sicker,'" the authors said. They speculated that the population studied often did not have enough time in the hospital for management of their illnesses. Commenting on limitations of their study, the authors note that they had few data on the PAC facilities themselves, so they could not determine what impact care variations may have had on readmissions. The authors concluded interventions that "focus on in-hospital and transitional care processes to ensure a patient is ready for hospital discharge" may aid in reducing early readmissions.

HRC Recommends: Given the increased attention to readmissions within 30 days of discharge and the federal government's use of financial penalties for certain readmissions that exceed a set target, organizations are looking more closely at readmissions to understand why they occur and to identify strategies to prevent unnecessary readmissions. Some organizations may want to conduct a root-cause analysis of all unplanned readmissions to identify contributing factors that the facility can take steps to address.