Background: Reducing early (<30 days) hospital
readmissions is a policy priority aimed at improving
healthcare quality. Unplanned readmissions are generally
considered undesirable events that often indicate relapse.
Although not necessarily a reflection of healthcare, they
may reflect on the effectiveness of the system of mental
healthcare as a whole.
Objectives: To describe trends in unplanned readmissions
to Illawarra Shoalhaven Local Health District (ISLHD)
hospitals following mental health admissions and examine
how these vary by service factors, specific conditions and
Methods: Retrospective longitudinal study of patients
attending ISLHD hospitals between 2002 and 2015 whose
major diagnostic category (MDC) was Mental Diseases
and Disorders (MDC 19) who have at least one unplanned
readmission within 6 months of discharge.
Findings: We found that 27% of patients admitted
in the MDC 19 category have at least one unplanned
readmission within 6 months of discharge – a higher
readmission rate than for other inpatients (20%).
Trends in the percentage readmitted since 2002 show
an approximately 40% decrease across all age groups
within 30 days of discharge. An increased risk of
unplanned readmission is associated with older age,
Aboriginal and Torres Strait Islander peoples, speaking
English as an additional language, no health insurance,
low socioeconomic status, an Index admission via the
emergency department, an emergency and with length
of stay (short stay ⩽2 days).
conclusions: Readmission risk prediction remains a
poorly understood and complex endeavour. Factors such as
medical comorbidities, basic demographic data and clinical
variables are much better able to predict mortality than
readmission risk. Broader social, environmental and medical
factors such as access to care, social support, substance
abuse and functional status contribute to readmission risk.
Readmission risk prediction is a complex endeavour with
many inherent limitations.