Australian Health Review August 2008 Vol 32 No 3 537 Planning and Development Aust Health Rev ISSN: 0156-5788 1 August 2008 32 3 537-547 ©Aust Health Rev 2008 www.aushealthre- view.com.au Planning and Development A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital Rick McLean, Kumara Mendis and Joe Canalese Abstract Objective: To examine the trend in unplanned readmissions (URs) to Dubbo Base Hospital (DBH) over the period 1996–2005 and assess possible correlations with basic demographic data. Results: URs increased over the study period, both as a total number and as a proportion of total admissions (from 4.7 to 5.4%), while average length of stay decreased from 5.3 to 4.4 days and available hospital beds decreased from 156 to 116. The proportion of URs for people aged 75 years has more than doubled over the same period. There were clear temporal variations in URs (greatest number occurring on Fridays and in late winter/early spring) and variations with age and gender (greatest number in young males; peaks for males in 0–10 and 71–80-year deciles and for females in 0–10, 21–30 and 71–80 year deciles). Fifty percent of URs occurred within 7 days of discharge. There was a statistically signifi- cant but small correlation between length of prior admission and time to readmission (Spearman correlation coefficient, 0.068; P < 0.01) although the time to readmission did not change over the study period. Chronic obstructive pulmonary dis- ease (3.8%), complications of procedures (3.6%), heart failure and pneumonia (each 2.2%), angina (2.1%) and acute bronchiolitis (1.8%) were the top causes of URs. Conclusion: URs are becoming more frequent in DBH; analysis of associations and trends over time are the first step in determining targeted Aust Health Rev 2008: 32(3): 537–547 measures to address the problem. HOSPITAL READMISSION RATES have been increas- ing during the last 5 years in developed 1-3 as well as developing countries. 4 Major concerns of readmission are the cost to the health services, financial implications and emotional distress to patients and their families and perpetuating dependency behaviour among patients. Further- more, a recent statement by the then Australian Government Minister for Health and Ageing suggests that a range of indicators including unplanned readmission rates are likely to be used to compare hospital performance into the future. 5 It has been reported that a lower quality of inpatient care increases the risk for unplanned early readmission in patients with heart failure, diabetes, or obstructive lung disease, 6 and a recent study concluded that adjusted rates of What is known about the topic? Hospital readmission rates have been reported to be rising but there is little published Australian data, and no comprehensive hospital studies. It has been suggested that unplanned readmission might relate to premature discharge and quality of care, and unplanned readmission rates have been proposed as a potential key performance indicator for comparisons between hospitals in Australia, as is already occurring overseas. What does this paper add? This paper confirms that the unplanned readmission rate to a major regional public hospital has risen over the last 10 years and that there is a small but significant negative correlation with prior length of stay. It highlights some key demographic factors that are associated with high rates of unplanned readmissions, and diseases which are more likely to result in unplanned readmissions. What are the implications for practitioners? The study shows that any hospital can analyse its data to provide valuable insights into factors around unplanned readmissions. Rick McLean, MD, Consultant physician; former Principal Medical Adviser, Department of Health and Ageing; and former Associate Dean Kumara Mendis, MB BS, Senior Lecturer Joe Canalese, MB BS, Associate Professor and Associate Dean School of Rural Health, Dubbo, NSW. Correspondence: Professor Rick McLean, School of Rural Health, PO Box 1043, Dubbo, NSW 2830. rmclean@med.usy.edu.au