title: Readmission rates and financial penalties after ear, nose and throat surgery: how can we improve?
abstract: BACKGROUND
  Since April 2011, all patient readmissions within 30 days have resulted in a financial penalty to the hospital trust, and therefore the responsible department. These costs may be substantial and potentially preventable.
  
  
  METHODS
  A service evaluation of readmissions within 30 days of discharge, over a 12-month period (January-December 2012), was performed in the ear, nose and throat department of a district general hospital, and findings were used as a basis to suggest areas for potential quality improvement.
  
  
  OBJECTIVE
  To determine the number of readmissions, causes of readmission and resulting costs, and to explore how these readmissions may be prevented.
  
  
  RESULTS
  The departmental 30-day readmission rate over the study period was 3.12% (81/2606). The commonest causes of readmission (33.3%) were complications following tonsillectomy (27/81) such as pain, infection or bleeding. Over a third of these patients (30/81) were readmitted for less than 24 hours, with the average length of stay being less than 2.5 days. Financial implications: In 2011 the trust had 7526 emergency readmissions which were eligible for penalty within the 30-day time frame. This resulted in a loss of income of more than £60 000 to the ear, nose and throat department.
  
  
  CONCLUSIONS
  Optimizing postoperative care and improving patient understanding of common complications may reduce readmission rates, thus limiting the financial burden on the trust. These areas could serve as a basis for future quality improvement projects.
authors.affiliation: Specialty Trainee 6.
authors.forename: J F
authors.initials: JF
authors.lastname: Danino
authors.affiliation: Foundation Year 2 Doctor.
authors.forename: T
authors.initials: T
authors.lastname: Taylor
authors.affiliation: Foundation Year 2 Doctor.
authors.forename: C W
authors.initials: CW
authors.lastname: Metcalfe
authors.affiliation: Specialty Trainee 4.
authors.forename: S J
authors.initials: SJ
authors.lastname: Muzaffar
authors.affiliation: Consultant Surgeon in the Department of Otolaryngology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH.
authors.forename: A
authors.initials: A
authors.lastname: Sinha
mesh_terms: D017048:Health Care Costs; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects*; D063886:Patient Discharge Summaries; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D011182:Postoperative Care; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D006113:United Kingdom