(427) Relationship Between Discharge Destination and Unplanned Readmission in Otolaryngology Patients

Introduction: While the rate of discharges to post-acute care (PAC) facilities continues to rise, readmissions from these facilities are common and poorly understood. We sought to 1) compare 30-day readmission rates for discharges from our Otolaryngology service to PAC facilities vs. other discharge destinations (ODD) and 2) analyze reasons for readmission for patients in each group.

Methods: A retrospective review was conducted on patients who were admitted to the otolaryngology service at a single tertiary academic center from September 2017 to August 2020. Patient charts were assessed for demographics, discharge destination, and reason for readmission, if a readmission occurred. Discharges to a skilled nursing facility, inpatient rehabilitation facility, or long-term care hospital were classified as a PAC discharge. Planned readmissions were excluded. Chi-square test was used to compare readmission rates and reasons between PAC discharges and ODD.

Results: 1832 patients were discharged over the study period, of which 136 (7.4%) were readmitted within 30 days. 240 (13.1%) patients were discharged to a PAC facility. Readmissions occurred at a higher frequency from PAC facilities compared to other destinations (PAC: n = 36 (15%); ODD: n = 100 (6.3%), p< 0.0001). 26.5% of total readmissions occurred from patients discharged to a facility. Common reasons for readmission included medical complication (PAC: n = 11 (30.6%); ODD: n = 35 (35%), p = 0.63), infection (PAC: n = 9, (25%); ODD: n = 42 (42%), p = 0.07), wound breakdown (PAC: n = 7 (19.4%); ODD: n = 20 (20%), p = 0.94), bleeding (PAC: n = 6 (16.7%); ODD: n = 14 (14%), p = 0.70), and functional issue (PAC: n = 3 (8.3%); ODD: n = 16 (16%), p = 0.26).

Conclusions: Discharge to a post-acute care facility represented a moderate proportion of total discharges but a significant proportion of readmissions. Increased communication and strengthening of relationships with specific post-acute care facilities with knowledge of otolaryngologic complications could decrease unnecessary readmissions.