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READMISSIONS: Diabetics with low blood sugar on last day of inpatient hospital stay are more likely to be readmitted

Potential approaches that may reduce the risk for readmission or death after discharge [for diabetes patients] include delaying patient release from the hospital until normoglycemia is achieved, modifying outpatient [diabetes] medications or advise patients to perform frequent glucose monitoring or use continuous glucose-monitoring devices.”

The relationship between low blood glucose levels and hospital readmission was studied in this large-scale analysis of over 800,000 admissions to Veteran Affairs hospitals over a period of 14 years. An inverse relationship was found – diabetic patients with low blood glucose levels (hypoglycemia) on the last day of a hospital inpatient stay were more likely to be readmitted to the hospital or to die within 180 days after discharge.

Source: Spanakis, E.K., and others. (2019, September). Association of glucose concentrations at hospital discharge with readmissions and mortality: A nationwide cohort study. JCEM. The Journal of Clinical Endocrinology & Metabolism, 104(9), 3679-3691. Click here for free full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642668/?report=printable  Posted by AHA Resource Center, (312) 422-2003, rc@aha.org

 

 

 

READMISSIONS: “Virtual ward” not proved beneficial in trial

The virtual ward model of providing post-discharge care was not found to be beneficial in reducing hospital inpatient readmission or death in a clinical trial conducted in Toronto, Canada.  Patients randomized to the virtual ward were considered to be at high risk for readmission, and were provided services such as telephone calls, home visits, and clinic visits.  Their care plan was coordinated by daily meetings of an interprofessional team.  Patients in the virtual care program did not have statistically significant differences in their outcomes compared to patients who received usual types care after discharge from the hospital.  The authors conclude that no argument can be made in support of investing resources in the operation of a virtual ward program.

Source: Dhalla, I.A., and others. (2014, Oct. 1). Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial. JAMA, 312(13), 1305-1312. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1910109 Posted by AHA Resource Center (312) 422-2050 rc@aha.org

The impact of nurse staffing on readmissions

To what extent does nurse staffing during hospitalization affect postdischarge outcomes? A recent article in Health Services Research explores three dimensions of this question:

  • the direct relationship between nursing unit staffing structure and hospital readmissions and emergency department visits within 30 days of discharge;
  • the indirect relationship due to quality of discharge teaching and patient readiness for discharge;
  • the economic relationship of investment in additional nurse staffing to cost savings in reduced postdischarge utilization.

Source: Weiss, M. E., Yakusheva, O. and Bobay, K. L. Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization. Health Services Research. Apr. 21, 2011. [Epub ahead of print] http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01267.x/abstract