Identifying Predictors of Emergency Readmission Within 7 Days of Hospital Discharge: A Prospective Cohort Study

Eisha Tir  Radiyah; Abdus Salam  Khan; Rabia  Imtiaz; Rida  Tariq; Fatima  Ali

doi:10.54112/bcsrj.v6i6.2126

Authors

Eisha Tir Radiyah Department of Emergency, Shifa International Hospital, Islamabad, Pakistan
Abdus Salam Khan Department of Emergency, Shifa International Hospital, Islamabad, Pakistan
Rabia Imtiaz Department of Paediatrics, Rockingham General Hospital, Perth, Australia
Rida Tariq Department of Emergency, Shifa International Hospital, Islamabad, Pakistan
Fatima Ali Department of Emergency, Shifa International Hospital, Islamabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2126

Keywords:

Aged, Emergency Service Hospital, Hospital Readmission, Malnutrition, Risk Factors

Abstract

Early return visits to the emergency department after discharge reflect gaps in transitional care and are associated with increased morbidity, healthcare burden, and costs. Objective: To determine the frequency of emergency department revisits within seven days of discharge and to identify associated clinical and demographic risk factors. Methods: A descriptive study was conducted at the Department of Medicine, Shifa International Hospital, Islamabad, from 5 November 2024 to 5 March 2025. A total of 275 patients discharged from the emergency department were enrolled using consecutive sampling. Patients aged 16 to 85 years, both sexes, were included. Data on demographic characteristics, comorbidities, length of hospital stay, and discharge clinical parameters were collected. Early readmission was defined as a return to the emergency department within seven days of discharge. Evaluated factors included advanced age, prolonged hospitalization, chronic illnesses, fever, tachycardia, anemia, hyponatremia, cognitive impairment, and malnutrition. Data were analyzed using SPSS version 26, with statistical significance set at p≤0.05. Results: Early readmission occurred in 26.2% of patients. Among readmitted individuals, 56.9% were aged 60 or older. Significant associations were observed with hypertension (p=0.001) and cognitive impairment (p<0.001). Nutritional deficits and anemia were highly prevalent among readmitted patients, affecting 69.4% and 65.3%, respectively. No statistically significant association was found between early readmission and gender, place of residence, or socioeconomic status. Conclusion: Older age, chronic medical conditions, cognitive impairment, malnutrition, and anemia are key predictors of early emergency department readmission. Targeted discharge planning, nutritional assessment, and structured post-discharge follow-up may reduce preventable emergency returns and improve patient outcomes.

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References

Dhaliwal JS, Dang AK. Reducing hospital readmissions. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: StatPearls Publishing.

Pedersen MK, Meyer G, Uhrenfeldt L. Risk factors for acute care hospital readmission in older persons in Western countries: a systematic review. JBI Database Syst Rev Implement Rep. 2017;15(2):454-485. https://doi.org/10.11124/JBISRIR-2016-003267

Glans M, Kragh Ekstam A, Jakobsson U, Bondesson Å, Midlöv

P. Risk factors for hospital readmission in older adults within 30 days of discharge: a comparative retrospective study. BMC Geriatr. 2020;20(1):467. https://doi.org/10.1186/s12877-020-01874-5

Sieck C, Adams W, Burkhart L. Validation of the BOOST risk stratification tool as a predictor of unplanned 30-day readmission in elderly patients. Qual Manag Health Care. 2019;28(2):96-102. https://doi.org/10.1097/QMH.0000000000000206

King L, Harrington A, Nicholls S, Thornton K, Tanner E. Towards reduction of preventable hospital readmission: older people and family members' views on planned self-management of care at home. J Clin Nurs. 2023;32(15-16):4599-4613.

https://doi.org/10.1111/jocn.16492

Cholack G, Garfein J, Krallman R, Feldeisen D, Montgomery D, Kline-Rogers E, et al. Predictors of early (0 to 7 days) and late (8 to 30 days) readmission in a cohort of acute coronary syndrome patients. Int J Med Stud. 2022;10(1):38-48. https://doi.org/10.5195/ijms.2022.1058

Cholack G, Garfein J, Errickson J, Krallman R, Montgomery D, Kline-Rogers E, et al. Early (0 to 7 days) and late (8 to 30 days) readmission predictors in acute coronary syndrome, atrial fibrillation, and congestive heart failure patients. Hosp Pract (1995). 2021;49(5):364-370. https://doi.org/10.1080/21548331.2021.1976558

Koch JJ, Beeler PE, Marak MC, Hug B, Havranek MM. An overview of reviews and synthesis across 440 studies examines the importance of hospital readmission predictors across various patient populations. J Clin Epidemiol. 2024;167:111245. https://doi.org/10.1016/j.jclinepi.2023.111245

Menditto VG, Fulgenzi F, Bonifazi M, Gnudi U, Gennarini S, Mei F, et al. Predictors of readmission requiring hospitalization after discharge from emergency departments in patients with COVID-19. Am J Emerg Med. 2021;46:146-149.

https://doi.org/10.1016/j.ajem.2021.04.055

Pershad J, Jones T, Harrell C, Ajayi S, Giles K, Cross C, et al. Factors associated with return visits at 7 days after hospital discharge. Hosp Pediatr. 2020;10(4):353-358. https://doi.org/10.1542/hpeds.2019- 0207

Sharma Y, Miller M, Kaambwa B, Shahi R, Hakendorf P, Horwood C, et al. Factors influencing early and late readmissions in Australian hospitalised patients and investigating the role of admission nutrition status as a predictor of hospital readmissions: a cohort study. BMJ Open. 2018;8(6):e022246. https://doi.org/10.1136/bmjopen-2018- 022246

Armitage MN, Srivastava V, Allison BK, Williams MV, Brandt-Sarif M, Lee G. A prospective cohort study of two predictor models for 30-day emergency readmission in older patients. Int J Clin Pract. 2021;75(9):e14478. https://doi.org/10.1111/ijcp.14478

Adania ET, Faria Junior GS, Franzoni NR, Pimentel SK. Emergency room readmission: an avoidable problem? Analysis and stratification of readmissions in a trauma reference center. Rev Col Bras Cir. 2024;51:e20243704. https://doi.org/10.1590/0100-6991e-20243704-

en

Fatima S, Shamim S, Raffat S, Tariq M. Hospital readmissions in internal medicine specialty: frequency, associated factors and outcomes. Pak J Med Sci. 2021;37(7):2008-2013. https://doi.org/10.12669/pjms.37.7.3575

Dafrallah S, Akhloufi MA. Factors associated with unplanned hospital readmission after discharge: a descriptive and predictive study using electronic health record data. BioMedInformatics. 2024;4(1):219-

https://doi.org/10.3390/biomedinformatics4010014

Maali Y, Perez-Concha O, Coiera E, Roffe D, Day RO, Gallego

B. Predicting 7-day, 30-day, and 60-day all-cause unplanned readmission: a case study of a Sydney hospital. BMC Med Inform Decis Mak. 2018;18:1. https://doi.org/10.1186/s12911-017-0580-8

Sharma Y, Miller M, Kaambwa B, Shahi R, Hakendorf P, Horwood C, et al. Malnutrition and its association with readmission and death within 7 days and 8-180 days postdischarge in older patients: a prospective observational study. BMJ Open. 2017;7(11):e018443. https://doi.org/10.1136/bmjopen-2017-018443

Iversen MKF, Buhl A, Schnieber A. Nutritional risk predicts readmission within 30 and 180 days after discharge among older adult patients across a broad spectrum of diagnoses. Clin Nutr ESPEN. 2024;61:288-294. https://doi.org/10.1016/j.clnesp.2024.03.027

Finn A, Naqvi R, Selvaraj V, Dapaah-Afriyie K. Rapid (7-day) readmissions to an inpatient medical service at a tertiary, academic medical center. Brown Hosp Med. 2022;1(2):36124. https://doi.org/10.56305/001c.36124