LAUSR

Objective and Background Hospital re-admissions contribute significantly to increased healthcare costs and have been a focus of various quality improvement initiatives at Baylor University Medical Center (BUMC). Re-admissions metrics are available at the hospital level not at the BMT program level. The goal of this study is to create a consistent methodology to identify BMT re-admissions, analyze the cause of the re-admissions on an ongoing basis to identify possible interventions to reduce preventable re-admissions and reduce morbidity. Method Patients that underwent an allogeneic BMT at Baylor University Medical Center (Dallas, TX) (BUMC) between January 2013 through December 2017 were included in this retrospective study. The BMT patients were identified from the hospital electronic medical record (EMR) system based on identifiers used in the internal transplant data management system and the Diagnosis Related Group (DRG) code assigned to the index transplant event. Any discrepancies identified in the data obtained from the EMR were resolved manually. Admissions in other services such as ICU and Oncology units at BUMC were included in the data. Including re-admissions to outside hospitals remain a challenge. Descriptive analysis was performed on the cohort of readmitted transplant patients. The frequencies of reasons, DRG codes, and International Classification of Diseases (ICD)-10 codes for readmission in the first year post-transplant were calculated. The patients were stratified into 30-, 60-, 90-, 180- and 365-day time points based on the number of days between the dates of transplant and readmission. Data clean-up and chart review was needed to clarify the data categorized by DRG or ICD-10 descriptions. Results More than 50% of the re-admissions among the BMT patients occur within the first 30 days post-transplant. The most frequent reason for readmission was infection or a fever (with or without positive culture). The cause for the re-admissions vary at different time points. Re-admissions at the 30 – 60 day point were more frequently related to graft-versus-host disease (GVHD), gastrointestinal complications and other reasons such organ failure. As the interval between transplant and readmission approaches 90 days or greater, the reasons are more evenly distributed. Conclusion A consistent review of BMT readmission data might be beneficial in identifying and reducing potentially preventable readmission causes and reducing morbidity. A more structured and intense follow-up process in the first 60 days post-transplant may be the most effective use of program resources. Patient education may benefit from being structured around different time point post-transplant. A review with the program Medical Director suggests a margin for discharge interventions such as education and patient expectation management at different time points post-transplant.