Decreasing readmissions: it can be done but one size does not fit all

Readmissions within 30 days of discharge are common, costly and hazardous—as such, efforts to reduce readmissions are a major focus in virtually all healthcare systems.1 In particular, policy makers have focused on heart failure (HF) as it is one of the most common reasons for hospitalisation in the developed world, HF patients already have the highest 30 -day readmission rates and despite substantial attention over the past decade to this problem the risk of post-discharge adverse events is actually increasing among patients with HF.1 ,2 While a number of interventions have been suggested to reduce readmission rates, their effectiveness in clinical practice has often been disappointing when rigorously evaluated.3 However, in this issue of BMJ Quality & Safety , Amarasingham and colleagues report a remarkably successful programme associated with a 27% relative reduction (a 5% absolute reduction) in 30 -day all-cause readmission rates in HF patients at Parkland Hospital in Dallas.4 This effect size was achieved even though the programme was only offered to approximately a quarter of discharged patients, was only deployed on weekdays (weekend discharges actually exhibit the highest rate of readmissions)5 and despite the fact that only a minority of readmissions may be truly preventable.6 ,7 Indeed, most …