Pre- and post-discharge factors influencing early readmission to acute psychiatric wards: implications for quality-of-care indicators in psychiatry

ObjectiveThis study aims to describe the association between pre- and post-discharge factors and early readmission to acute psychiatric wards in a well-integrated community-based psychiatric service.MethodsThe analysis consisted of all the hospital discharge records containing a psychiatric diagnosis in 2011 from four Italian acute inpatient wards. Socio-demographic, clinical, admission and aftercare variables were investigated as possible predictors of readmission at 7, 30 and 90 days after discharge and were analyzed, controlling for dependency among same-patient observations.ResultsPrevious psychiatric history was the most important predictor of readmissions. The socio-demographic and clinical characteristics of patients did not clearly influence readmission. Length of stay (LoS) was significant for readmission at 7 days even after controlling for other predictors and for same-patient dependence, in particular, for patients with previous admissions. Results suggest a protective role of a LoS higher than 28 days. In general, having a contact in community services did not turn out as protective from early readmission.ConclusionsThis paper contributes to increase the knowledge about factors that may predict the risk of early readmission. Implications for quality assessment in psychiatry emerged: readmission seems actionable by LoS and not by community follow-up.