An audit on general surgical readmissions

Abstract

Introduction: The objective of this study was to investigate general surgical readmissions at Salford Royal Foundation Trust (SRFT) and to assess the patterns of readmission in pathology and patient group characteristics. Methods: We performed a retrospective audit of patients re-admitted as an emergency within 30 days of being discharged by the general surgery team at SRFT over seven months from April 2018 to October 2018. Patient NHS numbers were provided by Hospital Episode Statistics via the Information Business Team at SRFT. Data was input into Microsoft Excel and statistical analysis was performed using StatsDirect 2018. Results: During this period, 171 patients were coded as general surgery emergency readmissions. Subsequent exclusion left 91 patients in our readmissions group. We compared this with 3261 patients who had been admitted to the general surgical team over the same time period. Gallstone pathology made up 26.4% of the readmission patients, but only 9.26% of all general surgical patients. 58.5% of the surgery on the readmission group was non-elective, compared to 29.7% of all patients. In the readmission group, patients who had a previous operation cancelled had higher rates of early post-operative complications per operation (0.6 complications per operation) from their subsequent operation, than patients who had no previous cancellations (0.229). Four patients (4.4%) had no discharge summary; another seven (7.7%) did not get any patient advice. For 16.5% of patients, the written discharge advice to them, or lack of such advice, was involved in their readmission. Conclusions: Gallstone pathology was over-represented in the readmissions group. Of the patients who had surgery on index admission, the readmission group had a higher proportion of non-elective surgery than all surgery patients. Written discharge advice was varied and inconsistent, and was not present for 12.1% of patients. Clearer discharge advice with more available written advice could reduce avoidable readmissions.