Volume 14, Issue 2, Pages 41 – 96 (2015)

Readmissions to hospital have been a hot political issue for several years. Most of us working in acute medicine will have managed patients who – with hindsight – should have stayed in hospital a bit longer. Pressures to shorten length of stay, as a result of rising admissions combined with reduced hospital bed numbers over the past two decades have inevitably contributed to this. The rhetoric of blame implied by the terminology of ‘failed discharge’ is unhelpful, but emphasises the need for vigilance in discharge planning. Financial penalties levied on hospitals for exceeding negotiated levels of readmission, combined with their use as quality indicators for acute medical units keeps this high up in the priority list for physicians and managers. However there is another side to this. For many patients, readmission is a consequence of their disease process, rather than a failure of clinical care. The timing of discharge for patients with frailty, chronic or terminal disease requires a complex balance to be struck – readmission may sometimes be avoidable by keeping a patient in hospital for longer, but this is not always what the patient wants. The article in this edition by Tim Cooksley and colleagues highlights this issue in a specific group of patients with cancer. Their conclusion is that, in this patient group, readmission to hospital is not a useful quality indicator. Although the study was conducted in a tertiary cancer care unit, the key messages are of relevance to those working in general acute medical units, where patients with cancer often represent a significant proportion of admissions. Furthermore the article mentions some interesting innovations, such as a telephone ‘hotline’, which may be of benefit to other groups of patients managed in the acute medicine setting.