Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic immune-mediated disease with significant morbidity and mortality that often requires inpatient hospitalization. SLE has one of the highest 30-day hospital readmission rates among chronic diseases in the United States with 30-day readmission rates reported in the literature of 16.5-36%. Prior studies have focused on identifying risk factors associated with readmission.  The aim of our study was to reduce 30-day readmission rates among SLE patients at the University of Colorado Hospital by implementing a multidisciplinary post-discharge intervention.

Methods: Using our inpatient consult log, we collected baseline data on the 30-day readmission rate of SLE patients from 7/2016 through 10/2016. We excluded patients who do not get their rheumatology care at our clinic as they would not be impacted by our intervention. We designed a post-discharge intervention that engages the rheumatology fellows, attendings and clinic nurses. We created a message template in the electronic medical record (EMR) that is sent by the rheumatology consult fellow to the clinic nurses when the patient is discharged from the hospital. This includes information about medication changes, future infusions, future labs and follow-up appointments. The nurses contact the patient by telephone within 48 hours of discharge to review the information and answer any questions.  We collected post-intervention data from 12/2018 through 2/2019.

Results: Prior to intervention, 87 patient charts were manually reviewed for inclusion and 18 patients met criteria of having SLE and being followed by our clinic. The 30-day readmission rate among these patients was 44%. The patients who were readmitted within 30 days were 100% female, average age 36 years old, 75% non-Caucasian (Hispanic or African American) and 50% had a public payor form of insurance (Medicare or Medicaid). The reasons for readmission were as follows: 37% SLE flare, 37% infection, 25% other medical issue.  Following our intervention, the 30-day readmission rate among our patients with SLE was 28%, which is a 16% decrease compared to pre-intervention.  Implementation of the intervention was assessed by documentation of the post-discharge message sent by the fellow to the nursing staff in the EMR.  This was found in 28% of hospitalized SLE patients. Of those patients who had the message and intervention performed, only 1 was readmitted within 30 days.

Conclusion: A quality improvement intervention involving a post-discharge telephone call decreased the 30-day readmission rate among patients with SLE followed at the University of Colorado rheumatology clinic from 44% to 28%.  There was overall low implementation of the intervention by the rheumatology fellows, however, this is likely because the intervention was preferentially performed for only the highest risk patients, which was effective in preventing readmission amongst these patients. In the future, we will be working towards more uniform implementation of our intervention. This is one of the first studies to describe a possible intervention to improve the unacceptably high hospital readmission rates among SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-quality-improvement-intervention-to-reduce-30-day-hospital-readmission-rates-among-patients-with-systemic-lupus-erythematosus/