Hospital readmissions are a frequent occurrence. They make up 20 percent of hospital admissions in the United States and 12 percent in Switzerland. Repeated hospital admissions are a burden on patients and their family members, and their high cost is not justified because one similar diagnosis accounts for the combined cost of two hospital stays. Studies show that one third of readmissions could have been avoided. However, a reliable method for identifying such patients had been lacking until now.
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Dr. Jacques Donzé, a senior attending physician at Department of General Internal Medicine of Inselspital (Bern University Hospital), developed just such a method while doing research in Boston. Based on a point system, the „HOSPITAL Score“ predicts which patients will most likely be admitted to the hospital again within a one-month period. Donzé then validated the test with a study including nearly 120,000 patients from nine hospitals in the USA, Canada, Israel and Bern. The study results will be published on March 7 in JAMA Internal Medicine (Journal of the American Medical Association).
The test includes the following risk factors (each letter represents a risk factor): low hemoglobin levels, discharge from oncology, low blood sodium, intervention (“procedure”), emergency admission (“index type urgent”), the number of admissions to hospital during the last year, and a stay of five days or more (“length”). Patients scoring more than 6 points are considered to be at risk of being readmitted to the hospital.
A targeted approached to preventing readmission
When the test detects an at-risk patient, further interventions can then be offered which reduce the risk of readmission. These include home care service, telephone contact following release, or educating patients about medication prior to discharge. Using the new test, these time-consuming interventions can be specifically targeted for those patients who will most benefit from them.
The day-to-day practicality of the HOSPITAL Score will now to be tested together with intervention packages specifically designed for at-risk patients in three hospitals.
Dr. med. Jacques Donzé, Senior Attending Physician, Department of General Internal Medicine, Inselspital, Bern University Hospital, +41 31 632 57 69.