Why do ischemic stroke and transient ischemic attack patients get readmitted?

Pratik Bhattacharya, Deependra Khanal, Ramesh Madhavan, Seemant Chaturvedi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective: Readmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences. Methods: Consecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30 days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined. Results: Two hundred sixty-five patients (50.9% male; 79.6%African American; mean age 60.9 years) were included. There were 205(77.4%) strokes and 60(22.6%) TIAs. Thirteen (5%) patients died during their first admission. Of the remaining 252 patients, 25 (9.9%) were readmitted within 30 days. The reason for readmission was neurological in 8/25 patients (32%; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68%). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5% vs. 14.7%; p = 0.001) An NIH stroke scale ≥ 10 predicted readmission (50.0% vs. 25.4% for NIHSS < 10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2% vs. 23.8%; p value = 0.01). Interpretation: Disabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30 days and determine best practices that prevent readmission.

Original languageEnglish (US)
Pages (from-to)50-54
Number of pages5
JournalJournal of the Neurological Sciences
Volume307
Issue number1-2
DOIs
StatePublished - Aug 15 2011
Externally publishedYes

Fingerprint

Transient Ischemic Attack
Stroke
Rehabilitation
Joint Commission on Accreditation of Healthcare Organizations
Health Care Quality Indicators
Nursing Homes
Practice Guidelines
African Americans
Electrolytes
Coronary Artery Disease
Demography
Physicians
Wounds and Injuries
Infection

Keywords

  • Acute stroke
  • Healthcare quality
  • Readmission

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Why do ischemic stroke and transient ischemic attack patients get readmitted? / Bhattacharya, Pratik; Khanal, Deependra; Madhavan, Ramesh; Chaturvedi, Seemant.

In: Journal of the Neurological Sciences, Vol. 307, No. 1-2, 15.08.2011, p. 50-54.

Research output: Contribution to journalArticle

Bhattacharya, Pratik ; Khanal, Deependra ; Madhavan, Ramesh ; Chaturvedi, Seemant. / Why do ischemic stroke and transient ischemic attack patients get readmitted?. In: Journal of the Neurological Sciences. 2011 ; Vol. 307, No. 1-2. pp. 50-54.
@article{a8dcc178bb3d44199f350b8656d5bb17,
title = "Why do ischemic stroke and transient ischemic attack patients get readmitted?",
abstract = "Objective: Readmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences. Methods: Consecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30 days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined. Results: Two hundred sixty-five patients (50.9{\%} male; 79.6{\%}African American; mean age 60.9 years) were included. There were 205(77.4{\%}) strokes and 60(22.6{\%}) TIAs. Thirteen (5{\%}) patients died during their first admission. Of the remaining 252 patients, 25 (9.9{\%}) were readmitted within 30 days. The reason for readmission was neurological in 8/25 patients (32{\%}; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68{\%}). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5{\%} vs. 14.7{\%}; p = 0.001) An NIH stroke scale ≥ 10 predicted readmission (50.0{\%} vs. 25.4{\%} for NIHSS < 10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2{\%} vs. 23.8{\%}; p value = 0.01). Interpretation: Disabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30 days and determine best practices that prevent readmission.",
keywords = "Acute stroke, Healthcare quality, Readmission",
author = "Pratik Bhattacharya and Deependra Khanal and Ramesh Madhavan and Seemant Chaturvedi",
year = "2011",
month = "8",
day = "15",
doi = "10.1016/j.jns.2011.05.022",
language = "English (US)",
volume = "307",
pages = "50--54",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",
number = "1-2",

}

TY - JOUR

T1 - Why do ischemic stroke and transient ischemic attack patients get readmitted?

AU - Bhattacharya, Pratik

AU - Khanal, Deependra

AU - Madhavan, Ramesh

AU - Chaturvedi, Seemant

PY - 2011/8/15

Y1 - 2011/8/15

N2 - Objective: Readmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences. Methods: Consecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30 days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined. Results: Two hundred sixty-five patients (50.9% male; 79.6%African American; mean age 60.9 years) were included. There were 205(77.4%) strokes and 60(22.6%) TIAs. Thirteen (5%) patients died during their first admission. Of the remaining 252 patients, 25 (9.9%) were readmitted within 30 days. The reason for readmission was neurological in 8/25 patients (32%; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68%). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5% vs. 14.7%; p = 0.001) An NIH stroke scale ≥ 10 predicted readmission (50.0% vs. 25.4% for NIHSS < 10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2% vs. 23.8%; p value = 0.01). Interpretation: Disabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30 days and determine best practices that prevent readmission.

AB - Objective: Readmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences. Methods: Consecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30 days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined. Results: Two hundred sixty-five patients (50.9% male; 79.6%African American; mean age 60.9 years) were included. There were 205(77.4%) strokes and 60(22.6%) TIAs. Thirteen (5%) patients died during their first admission. Of the remaining 252 patients, 25 (9.9%) were readmitted within 30 days. The reason for readmission was neurological in 8/25 patients (32%; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68%). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5% vs. 14.7%; p = 0.001) An NIH stroke scale ≥ 10 predicted readmission (50.0% vs. 25.4% for NIHSS < 10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2% vs. 23.8%; p value = 0.01). Interpretation: Disabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30 days and determine best practices that prevent readmission.

KW - Acute stroke

KW - Healthcare quality

KW - Readmission

UR - http://www.scopus.com/inward/record.url?scp=79959818012&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959818012&partnerID=8YFLogxK

U2 - 10.1016/j.jns.2011.05.022

DO - 10.1016/j.jns.2011.05.022

M3 - Article

C2 - 21636101

AN - SCOPUS:79959818012

VL - 307

SP - 50

EP - 54

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

IS - 1-2

ER -