S101 Predictors of and time frame for readmission following hospitalisation with community acquired pneumonia

Background There is a paucity of UK data to aid healthcare professionals in predicting which patients hospitalized with Community Acquired Pneumonia (CAP) are at greatest risk of readmission and to determine which readmissions may occur soonest. Methodology An analysis of CAP cases admitted between 1/1/2017 and 31/3/2019 to 9 hospitals in Northwest England participating in the Advancing Quality Pneumonia program. For entry into the AQ program, patients hospitalised with CAP require the diagnosis to be made by a Consultant Physician along with a chest radiograph compatible with pneumonia Results 12,144 subjects with CAP (mean age 73 years (SD 16)) were admitted during the study period. Mean Charlson Comorbidity Index (CCI) was 9.47 (SD 8.81) and in-hospital mortality was 14.7%. 2691 (26%) were readmitted within 30 days of discharge. Readmission was predicted by severe liver disease (aOR = 2.43), non-metastatic cancer (aOR = 1.72), Diabetes with complications (aOR = 1.64), Chronic Kidney Disease (aOR = 1.25), Congestive Cardiac Failure (aOR = 1.16), Ischaemic Heart Disease (aOR = 1.16) and longer Length of Stay (LOS). 24% of those readmitted had Pneumonia as the principal readmission diagnosis. 41% of readmissions occurred within 7 days of discharge; 25% between day 8–14 and the remaining 34% between 14 to 30 days post discharge. Comparing patients readmitted within 14 days with those readmitted 14–30 post discharge, earlier readmissions were older (72 years (SD 14.72) v 71 years (SD 14.08) p=0.01) and have a diagnosis of metastatic cancer (6.6% v 4.4%; p=0.02). Of the readmitted patients who had a comorbidity, none with Severe Liver Disease had a principal readmission diagnosis of Pneumonia compared with 23% of those with Ischaemic Heart Disease, 20% with Congestive Cardiac Failure, 27% with Metastatic Cancer and 23% with Non-Metastatic Cancer. Discussion A quarter of patients who survive to discharge following hospital admission for CAP are subsequently readmitted within 30-days; of those, two thirds are readmitted within 2 weeks pointing to an unacceptable quality of care. Many readmissions may be preventable by measures including implementation of in-hospital cross-speciality comorbidity management, convalescence in intermediate care, targeted rehabilitation and early clinical review in the community.