An Analysis of Factors Associated With Readmission Within Ninety Days From a Community Mental Health Rehabilitation Team

Abstract

Aims

Frequent readmissions present a challenge to both community and inpatient mental health services and are frequently used as a quality indicator. Service users who are readmitted also tend to have a poorer prognosis and can be characterised as ‘revolving door’ patients. Determining modifiable factors that affect rates of readmission may allow mental health services to target interventions such as to improve outcomes and service users’ experiences

Methods

The caseload of an inner-city NHS community rehabilitation team was examined for psychiatric admissions over the period from January 2022 to January 2023. This was divided into an admission group and a readmission group. Readmission was defined as service users who were admitted within ninety days of the index admission. A variety of factors related to the index admission and subsequent discharge were examined and compared between the two groups to identify factors associated with readmission.

Results

The community rehabilitation team caseload comprised of 122 care-coordinated service users. The readmission rate to an inpatient psychiatric ward between 1st January 2022 and 1st January 2023 was 37.5%. Factors that appeared to be protective against readmission were positive engagement with therapies during the index admission, such as dual diagnosis team, psychology, and occupational therapy. Additionally, service users who were discharged on a Community Treatment Order had significantly reduced rates of readmission. A shorter index admission was also associated with reduced rates of readmission. Involvement of the Home Treatment Team and medication changes in the week prior to discharge were not associated with reduced rates of readmission

Conclusion

The results of this study suggest that the provision of therapies by allied healthcare professionals should be prioritised in inpatient settings. Service users should be strongly encouraged to engage, and poor engagement may be considered an indication that the service user is not yet ready for discharge. Community Treatment Orders, where appropriate, should be considered to be protective against readmission. Longer inpatient stays may be associated with readmission since these service users are more likely to be severely unwell. Nevertheless, service users who require longer admissions are at high risk for readmission and interventions should be considered to mitigate this risk.