title: Inpatient Unit Heart Failure Discharge Volume Predicts All-cause 30-Day Hospital Readmission.
abstract: BACKGROUND
  All-cause 30-day hospital readmission is a heart failure (HF) quality of care metric. Readmission costs the healthcare system $30.7 million annually. Specific structure, process, or patient factors that predispose patients to readmission are unclear.
  
  
  OBJECTIVE
  The aim of this study is to determine whether the addition of unit-level structural factors (attending medical service, patient-to-nurse ratio, and unit HF volume) predicts readmission beyond patient factors.
  
  
  METHODS
  A retrospective chart review of 425 patients who resided in Maryland and were discharged home in 2011 with the primary diagnosis of HF from a large, urban academic center was conducted.
  
  
  RESULTS
  The patients were predominately (66.6%) black/African American, with mean (SD) age of 62.2 (14.8) years. Men represented 48.2% of the sample; 32% had nonischemic HF, 31.3% had preserved ejection fractions, 25.4% had implantable cardioverter defibrillators, and 15.3% had permanent pacemakers. Average length of stay was 6.0 days. All-cause 30-day hospital readmission rate was 20.2%. Inpatient unit HF discharge volume significantly predicted readmission after controlling for patient factors.
  
  
  CONCLUSIONS
  The study found that discharge from inpatient units with higher HF discharge volume was associated with increased risk of readmission. The findings suggest that in caring for patients with severe HF, inpatient unit HF discharge volume may negatively impact care processes, increasing the odds of hospital readmission. It is unclear what specific care processes are responsible. The discharge period is a vulnerable point in care transition that warrants further investigation.
authors.affiliation: Dzifa Dordunoo, PhD, RN Assistant Professor, Organizational Systems & Adult Health, School of Nursing, University of Maryland, Baltimore. Sue A. Thomas, PhD, RN Professor Emeritus, Organizational Systems & Adult Health, School of Nursing, University of Maryland, Baltimore. Erika Friedmann, PhD Professor and Associate Dean of Research, Organizational Systems & Adult Health, School of Nursing, University of Maryland, Baltimore. Stuart D. Russell, MD Associate Professor and Chief, Heart Failure and Transplantation, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Robin P. Newhouse, PhD, RN Professor and Dean, Science of Nursing care, Indiana University, Indianapolis. Bim Akintade, PhD, MBA, MHA, ACNP-BC, CCRN Assistant Professor and Specialty Director, AGACNP/CNS DNP, Organizational Systems & Adult Health, School of Nursing, University of Maryland, Baltimore.
authors.forename: Dzifa
authors.initials: D
authors.lastname: Dordunoo
authors.forename: Sue A
authors.initials: SA
authors.lastname: Thomas
authors.forename: Erika
authors.initials: E
authors.lastname: Friedmann
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.forename: Robin P
authors.initials: RP
authors.lastname: Newhouse
authors.forename: Bim
authors.initials: B
authors.lastname: Akintade
mesh_terms: D000368:Aged; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors