Abstracts

Rationale: Hospital readmissions have been identified as an important cause of escalating health care costs and decreasing preventable hospital readmissions is an explicit aim of a new national effort, the Partnership for Patients. Reducing readmissions has become a national target for health care reform, but this assumes that most readmissions are preventable. Very little has been published on reasons for readmissions in epilepsy patients. Without such information it is unclear if readmission rates are an appropriate measure of quality of care in this patient population. The objective of this study is to identify reasons for readmission within thirty days of epilepsy monitoring unit admission.Methods: Patients readmitted to our hospital from 1/1/2010 to 6/10/2011, with any diagnosis, and within 30 days of discharge from our epilepsy monitoring unit, were included in this analysis. We retrospectively analyzed, via manual chart review, the electronic medical record (relevant outpatient clinic notes and telephone encounters, ED visit notes, admission histories, inpatient consult and progress notes, video-EEG reports and discharge summaries) to identify reasons for readmission. Readmissions were classified as planned vs. unplanned and reasons for unplanned readmission were categorized as: recurrent symptoms of underlying disease, complication of index admission, medication-related event, pain management, venous thromboembolism, care planning issues, patient behavior or non-compliance, and reasons unrelated to index admission.Results: One hundred and sixteen consecutive readmissions from 1/1/2010 to 6/10/2011 were reviewed, representing an overall readmission rate of 8% for 2010. Forty-eight percent of readmissions were planned (e.g., a planned readmission for epilepsy surgery following video-EEG evaluation), resulting in an unplanned readmission rate of 4%. Nine percent of re-admitted patients had more than one readmission in this time period. Among the unplanned readmissions, the most common reasons for readmission were: recurrent symptoms/seizures (67%), post-op complications (12%), medication-related events (10%), and reasons unrelated to the index admission (8%). Among the unplanned readmissions, 82% (n = 49) had an index admission for elective video-EEG, of which 5 were nondiagnostic. In 18% of unplanned readmissions (n = 11), the index admission was for epilepsy surgery. Among the unplanned readmissions, 20% had confirmed non-epileptic seizures. The estimated rate of preventable readmissions was low.Conclusions: Nearly half of epilepsy readmissions were planned, a fact easily overlooked in national payment reform programs which treat nearly all readmissions, planned and unplanned, equally. Reasons for readmission are complex and multiple, but in this patient population the intractability of seizures appears to be the most common cause for readmission. Identifying reasons for readmissions is an important initial step toward the ultimate goal of reducing the number of preventable readmissions.