SHM Converge Scientific Abstract ePoster Gallery-Patient Reported Discharge Readiness and Reasons for Readmission

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This report examined whether patients’ feelings of discharge readiness were related to 30-day hospital readmission. Patients discharged from March 2023 to April 2024 who were readmitted within 30 days were screened, and 60 consented to interviews. They answered standardized questions about discharge readiness, discharge instructions, care management, and reasons for readmission. Their responses were recorded in RedCap, categorized, and analyzed alongside chart review data such as discharge diagnosis, destination, readmission date, source, and diagnosis.<br /><br />The background notes that readmission is a major problem influenced by patient vulnerabilities, social factors, and gaps in hospital support. The University of New Mexico Hospital’s Internal Medicine 30-day readmission rate was 13.43%. Prior research suggests that poor discharge preparedness may contribute to avoidable readmissions, but patient perspectives have historically been underused.<br /><br />Findings suggest mixed evidence on whether discharge readiness directly predicts readmission, but many readmitted patients reported feeling unprepared when they left the hospital. Patients described concerns about limited support for understanding discharge instructions, discharge plans, home circumstances, and chronic conditions. The discussion emphasizes that readmission risk may be reduced through interventions such as assessing patient needs, providing education, ensuring outpatient follow-up, and involving a multidisciplinary team of physicians, nurses, and case managers. Early case management involvement is highlighted as especially important to help patients leave the hospital with the tools and support needed for recovery.<br /><br />The conclusion is that patient perspective is an important but underutilized resource for identifying healthcare process failures that contribute to readmissions. Better discharge preparation and follow-up may help reduce avoidable 30-day readmissions.

Asset Subtitle

Chris Buntain

Meta Tag

Author List Chris Buntain, Christopher S. Bartlett, Darrick Kabsy, Vanessa Krajeck

Category Research

Concept Discharge Readiness

Concept 30-Day Readmission

Concept Readmission Risk

Concept Discharge Instruction

Concept Discharge Planning

Distinguished Non-Finalist

Presenter Organization University of New Mexico School of Medicine

Presenting Author Chris Buntain

Track Transitions of Care

Keywords

30-day readmission

discharge readiness

hospital readmission

patient perspectives

discharge instructions

case management

discharge planning

readmission risk

care coordination

follow-up care

Discharge Readiness

30-Day Readmission

Readmission Risk

Discharge Instruction

Discharge Planning