An examination of the nature and characteristics of patients readmitted to acute care from inpatient brain injury rehabilitation

Aim To describe the nature of readmission to acute care and identify patient characteristics associated with avoidable readmission to acute care from inpatient brain injury rehabilitation. Design A retrospective cohort design. Methods Data prospectively documented between 1 January 2012 ‐31 December 2018 in local clinical and administrative database were used. Patient medical records were accessed when missing data were identified. Descriptive statistics were used to describe the nature of readmission episodes and univariate and multivariable logistic regression were used to identify patient characteristics associated with readmission to acute care. Results Of the 383 patients admitted for rehabilitation, 83 (22%) experienced readmission to acute care for a total of 171 episodes. Thirty‐seven percent of readmission episodes were due to hospital acquired complications and therefore potentially avoidable. Infection accounted for 63% of hospital acquired complications. Patients with an avoidable readmission episode (N = 38) were more likely to have a significantly lower Functional Independence Measure score, be incontinent, have a tracheostomy, require a mobility aid, and be prescribed a dysphagia diet on rehabilitation admission. Patients with a tracheostomy on rehabilitation admission had a 56% probability for an avoidable readmission to acute care. Conclusion Brain injury rehabilitation patients with an avoidable readmission to acute care were more likely to have a higher burden of care on rehabilitation admission and infection was the leading cause of avoidable readmission episodes. Impact Research into readmission to acute care in the mixed brain injury inpatient rehabilitation population is limited. In this patient population, readmission to acute care is a contemporary issue that can occur at any time during a patient’s rehabilitation admission. This study provides valuable information informing practice change for preventing avoidable readmission episodes. Locally developed policy aimed at preventing readmission episodes should include proactive prevention, early recognition of complications and discrete escalation care pathways. 目标 描述再入院急性护理的性质，并确定与可避免的住院脑损伤康复入院相关的患者特征。 设计 回顾性队列设计。 方法 使用当地临床和行政数据库中2012年1月1日至2018年12月31日期间前瞻性记录的数据。当发现缺少数据时，可以访问患者的医疗记录。描述性统计学用于描述再入院事件的性质，单变量和多变量逻辑回归用于确定与再入院急性护理相关的患者特征。 结果 在383名接受康复治疗的患者中，有83名（22％）经历过再入院急症护理，共171次。37％的再入院事件是由于医院获得性并发症引起的，因此是有可能避免的。感染占医院获得性并发症的63％。发生可避免的再入院事件（N = 38）的患者更可能出现功能独立性评分显著较低、尿失禁、气管造口、需要助行器以及在康复