A survey of the documentation of unplanned readmissions following cardiac surgery

Aims: To quantify the frequency of unplanned readmission among cardiac surgery patients at a large teaching hospital; to identify reasons for readmission and to ascertain the comprehensiveness of related hospital documentation. Method: A retrospective survey of the content of documentation concerning unplanned readmissions following cardiac surgery. A semi-structured 31 item questionnaire was designed to collect information concerning a range of discharge and readmission data to be extracted from medical and nursing notes. Four cardiac liaison nurses then extracted these data for all patients who had undergone cardiac surgery over a period of one year and had been readmitted within 3 months. Findings: Data were collected for 65 patients. The mean length of stay for those who were readmitted was 16 days compared with 11.6 for all those treated over the 12 months. One-third of patients were informed they were going home on the day of discharge; half of the patients had no record of being informed of the timing of their discharge and there was a record of 30% of carers being informed of impending discharge. Documentation of services arranged appeared low. The main reasons for readmission were cardiac complications (52%) and infection (28%). Documented reasons for readmission focused on medical issues, but cardiac liaison nurses were able to identify additional reasons concerned with inadequate discharge preparation and social support. Pain and anxiety were the most frequently documented care needs on readmission. Conclusions:Nursing and medical documentation should include all details of discharge arrangements for patients who have undergone cardiac surgery; community-based health professionals need to be more aware of the subsequent problems of pain and anxiety; and a prospective longitudinal study of this group is needed to clarify the association between discharge preparation and readmission, and to identify risk factors for readmission.