Presentation Authors: Alice Crane*, Mohamed Eltemamy, Alvin Wee, Richard Fatica, Charles Modlin, Emilio Poggio, Venkatesh Krishnamurthi, Cleveland, OH
Introduction: Kidney transplant recipients often experience frequent ED visits and high early hospital readmission (EHR) rates. They are immunocompromised and expected to manage multiple new medications with frequent dosage adjustments in addition to standard post-surgical care. We sought to decrease our preventable EHR by intensifying and standardizing our discharge handoff and post-discharge follow-up. Herein we report our experience 1 year after implementation.
Methods: We retrospectively reviewed the demographics, hospital and post-discharge course for 486 adult kidney-only transplant recipients from 2015-2018. EHR was defined as admission to an inpatient facility within 30 days of index discharge. Data were analyzed using the chi-squared or 2-tailed t-test.
Results: Overall EHR rate was 20% (97/486). Significantly increased EHR rates were seen for black patients (28.7% vs 17.9% p=0.03), patients with prior transplants (29.9% vs 18.1%, p=0.018) and diabetics (27.1% vs 17.4% p=0.017). No difference was seen for sex, age, BMI, or donor source. In Sept 2017, discharge follow up was standardized based on prior work characterizing EHR at our institution. Follow up consists of warm handoff from inpatient to outpatient teams, provider phone call the day after discharge, and first clinic visit within 5 days. Since implementation, our EHR rates have decreased from 23.1% (76/329) to 13.4% (21/157) p=0.012. In addition, the disparity in EHR rates between black and white patients has decreased. Pre-intervention, the EHR rate for white patients was 20.1% (45/224) and for black patients was 32.9% (27/82) p=0.049. EHR rates are now 13.9% (17/122) for white patients and 15.4% (4/26) for black patients p=0.51. We have also experienced a shift in the main drivers of readmission with less EHR for acute anemia (11.8% of readmissions pre-intervention and 4.8% post), metabolic derangement & chronic anemia (14.5% pre vs. 0% post) and other medical causes (23.7% vs 19% post). EHR for surgical complications, infection, cardiopulmonary events, and rejection have remained unchanged.
Conclusions: Efforts to decrease early readmission rates in kidney transplant recipients were targeted at discharge handoff and patient contact in the first 10 days. Since implementation, we have seen a decrease in 30-day readmission rates from 23.1% to 13.4% while closing the gap between EHR rates between black and white patients. Standardized and frequent provider-initiated contact removes barriers for transplant patients and decreases unnecessary hospitalization.