الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The study of readmission to Gamal Abdel Naser Hospital in Alexandria was undertaken to fulfil the following items: ( 1 ) to measure the extent of this phenomenon, ( 2 ) identify the personal characteristics of the patients who were repeatedly’ admitted, as reg ards their age and sex, ( 3 ) the administrative features as their mode of admission, the clinical department .and the.length of stay, ( 4 ) their medical characteristics in each admission as diagnosis, investigations and treatment, and ( 5 ) to reveal the extent to which their admission is medically justified. The hypothesis was that a patient who is readmitted to the hospital within a short per iod of time may be an indication of the failure of the health care delivery system to provide compreheI\sive and continuous medical care of high quality, and the uneconomic use of the expens ive hospital resources. The period within which a second admission was regarded as a readmission was variable among the various previous studies, yet it was crucial to the definition of readmiss ion. The def ini tion of readmission in this study was taken literally and was not limited to any time period i.e. any admission which was preceded with another was reg arded as a readmission, and any admitted patient who had had a prevlous admission was reg arded as a hospi tal repeater. To define a standard rate for readmission that could be related to and incorporated into the general utiliza tioR review of the hospital, a one year period was taken to measure the extent of readmission. To have a more tho roug h view of the patients who were repeatedly admitted, a 5 year period was adopted to review their utilization experience. Thus all patients who were admitted more than once in the year 1980 were taken.” as the sample of study. Their medical records were retrospectively studied in that year and were reviewed back for their previous utilization experience to the start of the year 1976. Gamal Abdel Naser hospital was chosen as the study site, because it is the main general hospital of the Health Insurance Org ani za tion, a health delivery system which provides a comprehensive and continuous care to their beneficiaries who are the workers of industrial and govern mental institutions, and who are allocated to this hospital through a distinct referral chain from the general practi tioner to the specialist in outpatient clinics to the hospital and back. The hospital also has an emerg ency department which admits emergency cases directly. The study of readmission was facilitated by the estab lishment of the medical record unit number system where all readmissions of the patient could be traced easily, being in one file. The retreival of the records of readmiss ions in 1980 was difficult because there was no indications for their site in the reg istration system of the hospital. The abstraction, tabulation and analysis of data on readmission were all done manually, and were grouped under the following items: 1 Data relating vol-ume and extent of readmission to total admissions in the year 1980 and in the 5 years 1976-1980, as reg ards the number of cases, their episodes and days of care, averag e leng th of stay per case and per admission and their relation to the frequency of admissions (Tables 1,2,3,4). 2 Data related to personal characteristics as reg ards age and sex ln relation to number of cases, their episodes of admissions days of care, in each group and their relation with the frequency of admissions (Tables 5,6,7,8). 3 Data related to reason for admission, whether for the same, different or mixed conditions (Tables 9,10,11,12,13). Cases admitted for the same condi tions were defined as those exclusively admitted in all their frequencies with the same diagnosis, same etiological or pathological process, same anatomical site, operations and procedures and their copmplications and after care and cases of missdiagnosis. Cases admitted for different conditions were defined as those cases with no two same diagnosis in their total admission freq uencies. Mixed conditions we:.-e defined as those having same and different conditions within their episodes of admissions. The number of cases, their episodes of admissions, days of care average length of stay and average interval between admissions in each category of same, different and mixed conditions, and its relation to their frequency of admissions. 4 Data re.lated to mode of admission to the clinical services whether referred or not, the distribution of cases, number of episodes and days of care with the average leng th of st,ay in each clinical service and their frequency of admission to each department. (Table 14,15,16). They are compared to total admission to the clinical service (Table 17). 5 The distribution of cases, their episodes of admissions, days of care, averag e length of stay according to the international classification of diseases, (ICDA 8 ) and their frequency of admissions in each ca teg ory (Table 18,19). 6- The 17 most common conditions were chosen for the detailed study of number of cases, their episodes of admissions, days of care, average 1 eng th of stay and average interval between admissions .in each dia gnostic cond’i tion and their relation with their freq uency of admissions Table (20,21,22). Also the number of cases in each diagnostic condition and their distri bution according to whether admitted for the same, different :or mixed conditions. 7 Manag ement of , study cases who were admitted more than once for selected surg ical conditions (Table 23) . The results of the study showed that patients who were admitted more than once ln the year 1980 amounted to 1562 cases. They constituted 9.2 of the total number of patients admitted in that year. They experienced 21.8 of total admissions with an average of 2.76 admissions per’ case, and consumed 22.8 of total days of care wi th an average of 22.6 days per patient, compared to 7.8 days for those admitted only once. In the period of 5 years 53 of these cases had had previous admission experience before 1980. It was found that patients who had high freq uency of admissions in 1980 had also high frequency of admissions before. The total average number of admission per patient in the 5 years was 4.26 and the average days of care was 33.4 days per patient. The average number of. admissions per case was found to increase with age but was not related to sex. The average leng th of stay per case and per episode was found to in crease with increase >of age. Females consumed more day!? of care per case and wer:;~~,SOde than males.. The percentage of re~dmissions to the clinical services was highest in the departments of general medicine followed by general surgery, orthopedics and chest, being 40.4, 35.3, 20.9 and 18.7 respectively related to the number of study sample (1562) indicating that cases were readmitted in more than one clinical service. They were lowest in the departments of plastic surgery, hand surgery, ”neuro surgery and E.N.T. being 1.4respect ively. The highest number of admissions per case was in the departments of chest followed by general medicine being 5.7 and 3.4 admissions per case. It was lowest in hand surgery and E.N.T. departments being 1.5 and 1.7 , admissions per case respectively. The average length of stay per case was highest in the departments of plastic surgery, ophthalmic and urology departments being 47.9, 31.3 and 30.3 days respectively. It was lowest in the departments of E.N.T. hanCl. surgery and gynecology and obstetric departments being 9~3, 12.1 and 17.0 days respect ively. The average days ~f stay per admissions was highest in the departments of plastic surgery, urology and ophthal mology department being 21.9, 15.6 and 14.1 days respectiv ely. It was lowest in the departments of chest, E.N.T. and orthopodics being 5.1, 5.5, and 6.2 days respectively. The relationship f>etween the number of readmissions ln the 5 years 1976-1980 to total admissions in the year 1980 in the departments were as follows: 1/1 ln chest, 1/2.1 in general medicine, 1/2.3 in orthopedic, plastic and neurosurg ery departments. In the departments of gynecology and obstetrics it was 1/13.4, ln E.N.T. it was 1/12 and in general surgery it was 1/5.7. As regards the distribution of cases along the frequenc les of admissions cases in the departments of chest and general medicine were distributed along all frequencies, with the hig hest percentag e in the low frequencies and lowest in the high frequencies. In the rest of the depart ments cases were clustered around the 2-6 frequencies. As reg ards the mode of admission, more than 2/3 of admissions to the department of surg ery, orthopedics, plastic, hand and opthalmology were referred for admission. On the other hand more than’2/3 of admissions to the depart ment of chest, general- medicine were admitted as emergency. In the department of gynecology and obstetrics 92.5 of admissions were admitted as emerg ency . In the rest of the departments they had about equal percentage of referred and non referred admissions. Cases readmitted for the same condition, its sequele, or its complications constituted 69.2 of all cases re admitted. They experienced 70.6 of admissions and consumed 69.7 different experienced days of conditions. Those more days to those and 7.7 7.1 days interval was about of of readmitted for Those the days cases care. conditions amounted 8.96 of cases, they to 5.4 of admissions 4.9 and consumed of the care. The rest of cases were readmitted for mixed cases readmitted same for the condition had of and admissions compared care per case per readmitted different 33.4 conditions, for being days for those wi th same condi tion and 18.3 and for those with different conditions. The average between admissions for those with same condition 1/2 with different conditions that for those being 100 and 202 days respectively. The was more admitted distribution of stay per admission the leng th of or less similar re all of among groups cases as reg ards their , for’” admission. About reason 3 of admissions were for 1-3 days and about 34 of admis The sions were for 4-7 days and about 20 were for 8-15 days. between admissions were distribution of markedly readmitted 30 days the intervals different ambng cases different Those groups. for condition were readmitted within the same in admissions, days in within of about 40 60 about 60 of admissions and wi thin 90 days in about 70 of admissions. The corresponding figures for those admitted for different conditions were 14, 23 and 38. As reg ards the distribution of readmitted cases ln relation to the disease categories of the I . C . D A . 8 . , the cases admitted for diseases of the circulatory system accounted for the larg est percentag e (25.0), about 52 of which had ischemic heart diseases and about 10 rheumatic heart diseases. They experienced 18.6 of total admissions with an average of 3.2 admissions per case. Cases readmitted for diseases of the respiratory -system ranked second in the percentag e of cases (22.3). About 67 of which were admitted for the diagnosis. of asthma and its complications and 8.6 with. the diag nosis of pulmonary T. B. They ranked first as regards the averag e number of admissions per case (5.4) and in percentag e of total admissions (28.4). They consumed 17 of total days of care with an averag e of 25.3 days per case. They had the lowest averag e leng th of stay pe~, admission being 4.7 days. , Those cases readmitted for accidents constituted the . third ca teg ory in percentag e of cases (21.1), of which 43.6 were fractures of upper and lower limbs. They experienced relatively small percen tag e of admissions (9.6) of total admissions, with an average of 2.0 admis sions per case. They consumed 8.5 of. total days with an average of 13.5 days per case and 6.9 days per admission. The fourth group was formed of cases admitted for diseases of digestive system. They constituted 15.5 of cases. They experienced 5.9 of admissions with an average of 1.6 admissions per case. They consumed 6.2 of total days of care wi th an averag e of 13.5 days per case and 6.2 days per admission. ’” Cases admitted for diseases of blood and blood forming organs were the least in percentage of cases. They constit uted 0.7 of case.s and experienced 0.7 of admissions, but they had a high. average admissions per case (4.5). They consum.ed 1.4 of days with the highest average days of care per case being 66.2 days, and an averag e of 14.9 days of care per admission. Those cases with cong eni tal anomalies were second least in percentage rof cases they constituted 0.8 of total cases. They had the least percentag e of admissions (0.3) and the least percentag e of days of care (0.6), with an averag e of 29.2 days per case and 16.6 days per admission. In the review of some of the most common conditions from the group of cases readmitted for the same condition, it was found that 17 conditions constituted 73 of this group and 50 of total readmitted cases. Cases with chronic conditions like ischemic heart diseases and bronchial asthma ranked highest in their percentage of cases,. percent age of admissions and percentag e of days of care. Their admissions were more or less evenly distributed along all frequencies of admissions from two to more than 10 admissions. Bronchial asthma had the highest percentag e of cases, the hig hest percentag e of admissions and the hig hest percentag e of days of care, the highest number of admissions per case and were amO~ the shortest leng th of stay per admission. The corresponding figures were 16.7for cases, 3 2 . 1 ” for aqmissions, 18.1 for days of care and 8.3 admissions per case. The averag e interval between admissions was less than 3 months. Ischemic heart diseases came second, the corresponding figures were 14.6 for cases, 15.2- for admissions 17.5 for days of care, and 4.7 admissions per case. The averag e length of stay per admission was 8.8 days and the average interval between admissions was 140 days. , . The third ca teg ory of conditions were cases admitted with fractures of the lower limbs. They constituted 5.9 of cases, 4.”3 of admissions, 3..8 of days they had 3.1 admissions per case, and 6.9 days per admission and the averag e interval between admissions was about 45 days. Lumbar disc disorders came fourth in percentag e of cases, ( 5 . 4’ ) , . in percentag e of admissions (4.6~) , and percentage of days of had an averag e care (3:8). They length of stay of of 3.7 admissions per case, an average 6.4 days per admission and were readmitted within an average period of 113 days. Diabetes and its complications ranked fifth in this group in the percentage of cases (5..1) ,percentage of admis sions(’L5)( and in the percentage of days of care ,(6.1)” They had an average of 3.9 admissions per case, an average leng th of stay of 1°..4 days per admission and were re admitted within an average period of 111 days. Bilharziasis and its complications ranked sixth ~n this group. They were,.J. 1 . of cases, who exper ienced 2.5 . of admissions, and consumed 2.9. of days of care. They had an average of 3.5 admissions per case and an averag e of 9 days leng th. of stay per admission and were readmitted within a period of 137 days. The group of surg ical conditions ln this 9 roup which included piles, anal fistulae, apperidicits, hernia and skin infection constitute d about :So 3 of cases, 4.1 of admissions and 2.7 of days of care. The averag e admission per case ranged between 2- 2.3 admissions per case, the averag e leng th of stay per admission r.anged, between 4-7.7 days and the average interval between admissions ranged between 49 days to 216 days. They were clustered around the low frequencies of admissions., 2.9, 3.6 and 3.8.