The University of Kansas Hospital Cardiac Surgery Readmissions Committee

J. Baldwin¹, M. Whisenhunt¹, G. Zorn¹, R. Doonan¹, K. Winkler¹, K. Rice¹, T. Christopher. Crawford^2
1The University of Kansas Hospital, Kansas City, Kansas ²University of Kansas, Fairway, Kansas

Purpose: Unplanned readmissions affect 10-20% of cardiac surgery patients and are an important quality metric. In addition to the impact on hospital reimbursement, readmissions negatively impact mortality. The purpose of this study is to describe the inception of a multi-disciplinary readmissions group designed to combat cardiac surgery readmissions.

Methods: Cardiac surgery readmissions are defined as any unplanned readmission occurring within 30 days of discharge. Over the last 5 years, a cardiac surgery readmissions committee at the University of Kansas Hospital, led by advanced practice providers (APPs), and consisting of inpatient APPs, data managers, hospital administrators, emergency department personnel, cardiac surgeons, and outpatient APPs has taken shape. Beginning in 2023, a goal-oriented working group was established to combat readmissions. All cardiac surgery readmissions are submitted to the working group on a daily basis for review. The committee reviews each readmission and drills down on the driving forces impacting readmission and identified opportunities for intervention. The readmissions committee meets quarterly to discuss the state of readmissions and areas of opportunity.

Results: At our institution, cardiac surgery readmissions totaled 62 in 2022, including 27 patients undergoing isolated CABG. In 2023, our readmissions dropped to 40 total including 14 isolated CABGs (7.9%), despite an increase in total operative volume and an increased Case Mix Index (CMI). Through our working group's detailed investigation, we determined that arrhythmias (including atrial fibrillation), pleural effusions, and deep vein thrombosis (DVT)/pulmonary embolism (PE) were the most common causes for readmission. Regarding arrhythmias, we instituted postoperative amiodarone prophylaxis in our cardiac surgery patient population. For our pleural effusions, we have pursued aggressive drainage of the pleural spaces with thoracentesis. Upon discharge, our outpatient APPs carefully monitor our at-risk population via telephone calls to assess for unintentional outpatient weight gain and edema. As a group, we came to the consensus of starting prophylactic subcutaneous heparin on postoperative day 3 to combat DVT/PE which is now universally carried out. Finally, we have created a discharge checklist addressing rhythm issues, fluid balance, wound care, and clinic and on-call contact information. This is reviewed with each patient and family members by our discharge nurse coordinator and phone calls are made at 48 hours post-discharge by an outpatient nurse coordinator to reassess each patient.

Conclusion: The creation of the Cardiac Surgery Readmissions Committee Working Group at the University of Kansas Hospital allowed us to better identify reasons for postoperative readmission and design targeted interventions to reduce our readmission rate. As an APP-led working group, the integration of inpatient and outpatient care providers better enabled us to enact timely interventions for our at-risk cardiac surgery population to reduce readmission rates.

Identify the source of the funding for this research project: Department funding