A review of internal medicine re-admissions in a peri-urban South African hospital.
OBJECTIVE
To measure the re-admission rate and the number of preventable re-admissions in a secondary-level South African hospital, and to identify factors predictive of re-admission.


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


RESULTS
The re-admission rate for the 7 months ending October 2006 was 8.5% (262/3 083). Patients who were more likely to be re-admitted had chronic respiratory disease (odds ratio (OR) 4.2, 95% confidence interval (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 followup (OR 5.1, CI 2.6 - 10.3). Age distribution of re-admissions was bimodal, 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 cardiorespiratory illnesses. Half of re-admissions were judged to be potentially preventable, mainly through improved patient education.


CONCLUSIONS
One in 12 general medical patients was readmitted. Chronic diseases and inadequate patient education and discharge planning accounted for the largest group of re-admissions in older patients. Re-admission of HIV/AIDS patients has generated a second peak in younger individuals, and the impact of the antiretroviral roll-out on admission rates warrants further scrutiny.
Stanley
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Department of Medicine, Groote Schuur Hospital, Cape Town. alanmstanley@yahoo.co.uk
Graham
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Parrish
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006786:Hospitals, Urban; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors