From the Guidelines
Hospital readmission rates after stroke in the first 3 months can be significantly reduced with comprehensive discharge planning and transitional care, aiming for a rate below 12%. The most recent and highest quality study, 1, emphasizes the importance of an interprofessional effort in preventing poststroke complications and hospital readmissions. Key factors contributing to readmissions include poor preparation before discharge, insufficient medication reconciliation, lack of education on anticipated needs and resources, and limited support to receive available community services.
To minimize readmission risk, several strategies can be employed:
- Adherence to prescribed secondary prevention medications, including antiplatelet therapy, statins, and antihypertensives, as outlined in 1.
- Early follow-up within 7-14 days of discharge, as suggested by 1, which highlights the importance of timely and detailed discharge summaries.
- Comprehensive patient education about warning signs requiring immediate medical attention.
- Addressing modifiable risk factors such as smoking cessation, diabetes management, and physical activity.
- Implementation of structured transitional care programs, which have been shown to decrease readmissions by approximately 20-30%, as noted in 1.
The use of discharge plans, as discussed in 1, is associated with improved outcomes, including significantly reduced length of hospital stay, reduction in readmissions at three months, and greater caregiver preparedness. Therefore, a multifaceted approach that includes these elements is crucial in reducing hospital readmission rates after stroke in the first 3 months.
From the Research
Hospital Readmission Rate after Stroke in the First 3 Months
- The hospital readmission rate after stroke is a significant concern, with studies indicating a high rate of readmissions within the first few months after discharge 2, 3.
- According to a study published in PloS one, the readmission rate within 30 days after initial discharge was 9.7%, and 22.2% of patients were readmitted within 2019 2.
- Another study published in the Journal of stroke and cerebrovascular diseases found that 18.8% of patients were readmitted within 90 days, and 24.5% were readmitted between day 91 and 365 3.
- The most common causes of readmissions were stroke and post-stroke sequelae, followed by sepsis and acute renal failure 2.
- Factors associated with increased risk of readmission included older age, longer initial lengths of stay, modifiable comorbidities, and social determinants such as living in an urban setting and having Medicare insurance 2.
Comparison of Readmission Rates and Causes
- A study published in Stroke found that among Medicare beneficiaries aged >65 years who survived hospitalization for an acute ischemic stroke, more than half had died or been readmitted at least once during the first year after discharge 4.
- The reasons for hospital readmission varied over time, with stroke remaining a leading cause for readmission, and pneumonia or respiratory illnesses being the most common diagnostic category associated with readmission 4.
- Another study published in Clinical pharmacology: advances and applications found that all oral anticoagulants were more effective than antiplatelet agents at reducing the risk of ischemic stroke and all strokes 5.
Predictors of Readmission
- Early readmission was associated with older age, impaired physical function, atherosclerotic etiology of index stroke, and a higher risk factor burden 3.
- Late readmission was associated with older age and prior myocardial infarction 3.
- Patients at increased risk of readmission had longer initial lengths of stay, modifiable comorbidities, and social determinants such as living in an urban setting and having Medicare insurance 2.