Factors associated with recurrent unplanned hospital visits at Khayelitsha District Hospital, Cape Town, South Africa
Date
2019-04
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Background:
There is a worldwide trend towards decreasing the length of hospital stay as a result of bed pressure and an attempt to decrease hospitalization costs. Khayelitsha has a high population density, with a high disease and social burden. KDH needs a rapid bed turnover to meet local demands. This arguably occurs at the price of decreased quality of care and perpetuation of the revolving door phenomenon. The 30 day readmission rate is becoming a benchmark for hospital quality of care assessment. Repeated unplanned hospital visits occur commonly among medical patients at KDH.
Aim:
To identify the factors associated with unplanned hospital visits amongst adult medical patients at KDH.
Setting:
The internal medicine department at KDH.
Design:
A descriptive cross-sectional study was conducted by means of folder reviews, evaluating medical admissions and unplanned hospital visits (UHV) during the preceding 30 days of medical admissions over a 2-month period. The prevalence of UHVs during the preceding 30 days of medical admissions was measured. Factors associated with UHVs prior to admission were identified and reasons for avoidable readmissions were determined.
Results:
A total of 407 patient folders were evaluated. The prevalence of UHV was 21.9%. Avoidable readmissions accounted for 37.1% of admissions. Chronic diseases, poorly managed HIV, decreased mobility and shorter hospital stay were the drivers for recurrent hospital visits. Diagnostic errors (39%), complications of admission (24.2%) and too early discharge (15.1%), p < 0.001 were the most common reasons for avoidable admissions.
Conclusion:
More than 20 percent of medical admissions visited the hospital in the preceding 30 days and more than one third of these admissions were avoidable. Chronic diseases, poorly managed HIV, decreased mobility and shorter hospital stay were the drivers for recurrent hospital visits. Diagnostic errors, complications of admission and too early discharge were the most common reasons for avoidable admissions. Recurrent hospitalisation was associated with increased morbidity and mortality. Early identification of patients at risk of readmission may guide interventions to reduce readmissions. Decreasing the readmission rate by better clinical care and discharge planning may be a viable strategy to improve hospital efficiency in terms of cost reduction and improved quality of care.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MFamMed)--Stellenbosch University, 2019.
Keywords
Hospitals -- Admission and discharge -- South Africa, Hospital utilization -- Length of stay -- South Africa, UCTD