30-Day Readmission and Mortality (Death)

Readmission and mortality are two measures of quality that are complex and are easily misunderstood. When comparing these numbers among healthcare providers, it is important to understand how they are measured.

30-Day Readmission

30-Day Readmission is when patients who have had a recent hospital stay need to return to any hospital for any reason again within 30 days after leaving. Ideally, excellent care coordination and patient support should help reduce the number of patients who are readmitted to the hospital within 30 days. However, the rules around the reporting of these numbers can be misleading.

Example #1) a cyst may be discovered during a routine ultrasound for a pregnant woman. The cyst may not need to be addressed right away so it is decided by the patient and her doctor that she will wait until after the baby is born to have it removed. The woman delivers her baby and returns home. Two weeks later she returns to the hospital to have the cyst removed, as planned. This second time in the hospital is counted against the healthcare system as a 30-day readmission.

Example #2) a man is admitted to the hospital for a total knee replacement that he chose to have done. He has no problems with the surgery, nursing care and rehabilitation and leaves the hospital after 3 days. Three weeks later, he's involved in a car accident and is readmitted to the hospital. This also counts against the healthcare system as a 30-day readmission.

Even though there are good questions around the 30-Day Readmission reporting, at UnityPoint Health, we believe that the tracking of this information is useful to us as we look at the services we provide within our health system. Even knowing that there are many good reasons for a patient to be admitted into a hospital twice within 30 days, we focus on lowering readmissions, because, overall, coordinating care better will decrease the number of unnecessary readmissions. It is one tool we use to make sure you are getting the highest quality care and coordination of services after you leave the hospital.

30-Day Mortality

30-Day Mortality is defined as patients who die within 30 days of being in the hospital. When dealing with otherwise healthy patients who are not of extremely advanced age, UnityPoint Health believes that surrounding patients with a team of doctors, nurses and other staff who talk with each other about the care of their patients, regardless of the setting (clinic, hospital, or home), leads fewer deaths within 30 days of leaving the hospital. 

The mortality rate is adjusted by the Centers for Medicare and Medicaid Services to take into account how sick patients are before they are admitted to the hospital. However this measurement, like the readmission measurement, is not perfect. It does not account for whether or not the patient has a Do Not Resuscitate (DNR) order on file if their heart stops beating or they stop breathing. 

This is an example of how the numbers could be misleading: a 90 year old woman with an order not to resuscitate is admitted to the hospital from a nursing home for pneumonia. During her stay, she becomes sicker to the point she stops breathing. Abiding by the wishes of the patient, no measures are taken to revive her. This death is considered part of the hospital's 30-day mortality rate even though the patient's wishes were followed.

While some deaths may not be preventable, it is possible that a hospital with a number higher than the national average may not be using proven practice to care for some patient groups. Evidence-based procedures or evidence-based practices are things that have been proven through national and/or international research that are accepted by doctors and medical researchers as the best way to care for or treat certain conditions or illnesses.

That's why at UnityPoint Health we track this information closely; to ensure our doctors and nurses use evidence-based practices in the care of all patient groups.

The hospital mortality rate and the rate of readmission are based on people who have Medicare for their insurance, who are 65 years or older. People who have Medicare and who are 65 or older who are discharged from the hospital and do not go home but instead go to a nursing home are also included in this data.

View UnityPoint Health Hospital Reports