• Ajay Dharod, Brian J Wells, Kristin Lenoir, Wesley G Willeford, Michael W Milks, and Hal H Atkinson.
• From the Department of Internal Medicine, Section on General Internal Medicine, the Department of Biostatistics and Data Science, and the Department of Internal Medicine, Internal Medicine Residency and Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, the Department of Internal Medicine, Section on Infectious Diseases, University of Alabama, Birmingham, and the Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus.
• South. Med. J. 2019 Jun 1; 112 (6): 338-343.

ObjectiveAcademic medical centers face unique challenges in educating physician trainees in effective discharge practices to prevent readmissions. Meanwhile, residents must handle high workloads coupled with frequent rotations to different services. This study aimed to determine whether daily service census, service turnover, time of discharge, and day of discharge increase the risk of 30-day readmission.MethodsAll of the discharges from two academic general internal medicine teaching services between October 1, 2013 and September 30, 2014 were included in this observational data analysis. Variables were fit to a 30-day, all-cause readmission outcome using multiple logistic regression with inverse probability of treatment weighting and multiple imputations with chained equations. The following potential confounding variables were included in the model: health system utilization, demographics, laboratory values, and comorbidities.ResultsAmong 1935 total discharges, 258 patients (13.3%) were readmitted within 30 days of the index discharge. Turnover, service census, weekend discharge, and time of discharge were not significantly associated with the risk of readmission. Patients discharged during holiday periods had higher odds of readmission (odds ratio 2.56, 95% confidence interval 2.01-3.25), whereas patients discharged on an intern switch day had lower odds of readmission (odds ratio 0.33, 95% confidence interval 0.27-0.41).ConclusionsPatients who are discharged during holiday periods are at a higher risk of readmission after adjusting for potential confounders. These results also suggest that discharge on an intern switch day had a protective effect on readmission. Further work is needed to examine whether these findings can be replicated, and, if confirmed, to determine to what extent these associations are causal.

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