Given the current climate of healthcare and the significant disruption that hospitalization brings to an individual's life, it is critical to identify and understand the factors that may predict readmission. Rapid or frequent readmissions, as a subgroup of readmissions, are particularly problematic (Sullivan, Young, & Morgenstern, 1997). It is estimated that rapid readmissions account for 45-53% of admissions and that 30-35% of inpatients account for as much as 80% of the allocated mental health dollars (Sullivan, Wells, Morgenstern, & Leake, 1995). Weiden and Olfson (1995) estimate that multiple readmissions among individuals with schizophrenia alone cost approximately $2.3 billion annually.
This study examined modifiable risk factors related to rapid readmission to a psychiatric inpatient hospital in a population of patients with severe and persistent mental illness. Participants were 81 patients admitted to a public regional state hospital. Inclusion criteria included being admitted during the identified 6 month time period, meeting criteria for severe and persistent mental illness, having an initial (index) admission that was at least 24 hours, no diagnosis of mental retardation or dementia, and the patient did not have a sole diagnosis of substance abuse. Patients with an identified rapid readmission episode during the 6 month period were compared to those without a readmission episode on identified modifiable factors: (a) length of stay, (b) therapeutic involvement, (c) medication changes, and (d) instability at discharge. It was hypothesized that patients with shorter length of stays, lower levels of therapeutic involvement, medication changes prior to discharge, and instability present prior to discharge would have more rapid readmission episodes.
None of the original hypotheses were supported. No significant correlations were found for therapeutic involvement, medication changes, or instability prior to discharge. In direct contradiction to the hypothesis regarding length of stay, patients who spent more days in the hospital appeared to be quicker in returning. This was explained in terms of the severity of illness and the likelihood that the treatment milieu was the more stable placement for these severely disturbed individuals.
Future research should continue to study those with longer hospital stays, and specifically at-discharge issues and type of service history, in order to better understand what factors influence their likelihood to have a rapid readmission episode.