A Retrospective Chart Review of Hospital Based Wound Discharge Planning and 30-Day Readmission Rates

Abstract

<bold>Background</bold>: Healthcare institutions are examining ways to reduce costs and to improve the quality of care through both discharge planning and follow-up appointments which aim to avoid unnecessary readmission. Based on a recent thesis (Kyles, 2011), 83 patients with both a wound related complication and same-cause diagnosis consisted of 5% of the 1,781 readmitted patients. Patients with wounds comprise the largest population discharged from HMC, but wound care in particular requires adequate supplies and equipment which underserved patients likely cannot afford. Therefore, more attention given to the development of thorough and efficient discharge planning for patients discharged with wounds will likely help lessen the financial burden on public institutions. <bold>Purpose</bold>: The research was focused on finding gaps in discharge planning by describing the current discharge information for patients who are discharged with wounds, evaluating differences between discharge plans for clinic follow-up and actual clinic follow-up, comparing patient characteristics between patients readmitted at 30 days for a wound-related problem to those who were not readmitted, and identifying patient characteristics or post discharge care related to 30-day readmission for a wound problem. <bold>Design</bold>: A retrospective cohort study of a total of 82 subjects was obtained from an electronic surveillance system. Convenience sampling was used to identify patients with wounds diagnosed based on ICD-9 code. This study included patients who had been discharged with acute or chronic open wound issues and collected data on their post discharge care, and information on readmission (or non-readmission). Data were collected using a structured data collection form to identify patient characteristics, demographics, wound discharge planning, phone call management, clinic follow-up, and 30-day readmission outcomes. <bold>Results</bold>: A comparison of patient characteristics between patients readmitted within 30 days and those not readmitted, showed readmitted patients were older age, had shorter length of stay, more medications prescribed at time of discharge, and more ED visits after discharge from the hospital. Both groups were found to have a mean BMI over 30.0 (obesity). An interesting, and possibly clinically important, finding was that among the 13 patients discharged to a home with services (visiting nurses), none were readmitted to HMC. Less than half of sampled patients' discharge summary included PCP information, and 20 out of 82 wound care plans were not addressed in the discharge summary. Only half of the total sample had received the wound care instructions in the discharge instruction. A lack of wound care instruction was one possible factor that might have increased the likelihood of readmission between the readmitted patients and the non-readmitted. <bold>Conclusion</bold>: The process of open acute or chronic wound to healing is a continuous process and often not complete at the time of discharge. Discharge plans, discharge summaries, discharge instructions, and patient education are crucial for a patient with an open wound. Lack of wound care instruction, post discharge care and some patient characteristics are factors identified in this study that might increase likelihood of readmissions. However, further exploration of the factors and their relationship to readmissions is needed to better understand how to improve care and reduce the need for readmission.