Monitoring 30-day readmissions of older people: should this be adopted as a performance indicator for national clinical audits?

Introduction: 

The NHS routinely publishes data on hospitals’ 30-day readmissions. Readmission data is not yet collected by the National Hip Fracture Database (NHFD) or National Emergency Laparotomy Audit (NELA). We examined whether such data might provide a useful care quality indicator. 

Method: 

Retrospective review of 30-day readmissions after hip fracture or emergency laparotomy between January-March 2025 using local NHFD, NELA and electronic health records. We examined reasons for and impact of readmissions, whether any might have been avoided, and how. 

Results: 

The NHFD recorded 122 patients, of whom 18 (15%) were readmitted, two of them twice. Twelve (67%) were women and 13 (72%) were aged >80. Six (33%) died during readmission. Most readmissions (n=14, 70%) were for pre-existing comorbidities. Three others were for day-case Dopplers (all negative). Just 3 (2.5%) readmissions were associated with the index presentation (a pressure sore arising after discharge; a scan that excluded pulmonary embolism; a fall causing hip wound breakdown).  

Among the 37 NELA cases there were 3 readmissions (8%). Two (67%) were women and none of the readmissions were aged >80. After excluding readmissions that were related to pre-existing comorbidities, only one (3%) patient was readmitted due to the index presentation, which was for a surgical complication of the laparotomy. 

Conclusions: 

Initial readmission rate was 15% in NHFD and 8% in NELA data, however after excluding readmissions related to pre-existing co-morbidities this figure was revised to 3% - demonstrating that 97% of both NHFD and NELA cohorts were not readmitted for reasons related to their index presentation. Most readmissions were related to other conditions, especially in the older hip fracture cohort. This retrospective review was useful as an element of local clinical governance, but it would be inappropriately burdensome to make 30-day readmission monitoring a routine metric across the 100,000 cases/year of these audits.