A review of Internal medicine readmissions in a peri-urban South African Hospital

Abstract

Objective: Measurements of the readmission rate and the number of preventable readmissions in a level II South African Hospital, and the identification of factors predictive of readmission.

Methods: The admission register for the medical wards at Cecilia Makiwane Hospital (CMH) was used to identify readmitted patients, whose folders were reviewed. A comparison group of patients who were not readmitted was randomly generated from the same register.

Results: The readmission rate for the seven months ending October 2006 was 8.5% (262/3083). Patients who were more likely to be readmitted had chronic respiratory disease (OR 4.2,95% CI 1.2 - 14.6), HIV infection (OR 5.0, CI 2.1 - 12.0), were older than 50 years (OR 5.2, CI 2.5 - 10.9), Had a first admission of more than 8 days (OR 3.2, CI 1.5 - 6.6) or a booked medical outpatients follow-up (OR 5.1, CI 2.6 - 10.3). Age distribution of readmissions wasbimodal with HIV positive individuals (27.4% overall) accounting for 50% of all admissions younger than 50 years, but only 9.1% of those 50 years or older. In individuals older than 50 years, 42.1% of admissions were due to chronic cardio-respiratory illnesses. Half of readmissions were judged to be potentially preventable, mailnlu through improved education.

Conclusion: One in twelve general medical patients was readmitted, with chronic diseases accompanied by inadequate patient education accounting for the largest group of readmision in older patients. Readmission of HIV/AIDS patients has generated a second peak in younger individuals, and the impact of the antiretroviral roll-outon this warrants further scrutiny.