Objective::Unplanned 30-day readmissions result in increased costs and decreased patient satisfaction. The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focused on patient and staff education, use of targeted skilled nursing facilities, and appropriate use of patient observation status.Methods::This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3-year period between October 2015 and September 2018. In October 2016, the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery. These changes included enhancing patient education, increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses, and appropriate utilization of 23-h observation status for returning patients. The readmission rate from the pre-intervention era (October 2015 through September 2016) was compared to the readmission rate from the post-intervention era (October 2016 through September 2018). Secondary outcomes were the rates of 23-h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge.Results::In this sample of 449 patients, 161 (35.9%) were observed before the change-in-practice (before October 2016), and 288 (64.1%) were observed following the change-in-practice (after September 2016). On univariable analysis, the risk of readmission declined by approximately 41.4% from the pre-intervention era, though this conclusion was not statistically significant ( P= 0.06). On multivariable analysis, patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days ( P = 0.03). Similarly, those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days ( P= 0.001). No patient characteristics were associated with a 23-h observation following discharge (all P > 0.05). Conclusions were similar for emergency room visits following discharge. Conclusions::A three-part quality improvement strategy resulted in a clinically important decrease in 30-day readmissions, though the decline was not statistically significant. There were no significant changes in 23-h observation within 30 days of discharge or emergency room visits within 30 days of discharge.

30-day readmissions;head and neck oncology;healthcare utilization

Yang Sara;Adams William;Bier-Laning Carol

Department of Otolaryngology—Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA;Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA

世界耳鼻咽喉头颈外科杂志（英文）

[1]Yang Sara;Adams William;Bier-Laning Carol-.Head and neck cancer readmission reduction (HANCARRE) project: Reducing 30-day readmissions)[J].世界耳鼻咽喉头颈外科杂志（英文）,2022(02):158-166

HANCARRE,extirpative,handoffs,readmit

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