Indicator 14: Readmission to hospital within 28 days of discharge

Key messages:

• In 2010-11, the percentage of admissions to state and territory acute psychiatric inpatient units that were followed by a readmission within 28 days was 15% nationally. This figure has been stable since 2005-06.
• Two states had readmission rates lower than 10% in 2010-11: the Australian Capital Territory (5%) and South Australia (9%). South Australia's figures should be interpreted with caution because they may represent an undercount.
• There has been little movement over time in almost all states and territories, except in the Australian Capital Territory where the rate has more than halved since 2005-06.

Internationally, readmission rates are often used as a litmus test of the performance of mental health systems. High rates may point to deficiencies in hospital treatment or community follow up care, or a combination of the two. Of course, other factors may also be implicated in rapid readmissions, with some reflecting the episodic nature of mental illness. Notwithstanding the complexity of the indicator, it is used by many countries to monitor health system performance. It has special relevance to areas of health care that involve provision of services to people with longer term illnesses who need a combination of hospital and community. based treatment. The underlying standard is that, while multiple hospital admissions may be necessary over the course of a lifetime for some people with ongoing illness, a high proportion of unplanned readmissions occurring shortly after discharge largely reflects failures in the care system.

This indicator focuses on admissions to acute psychiatric inpatient units run by state and territory mental health services; comparable data for the private hospital sector are not available. Figure 60 presents the national average for each year from 2005-06 to 2010-11, and shows that with the exception of one year (2009-10) when it dropped to 14%, it has consistently sat at 15-16%.

More detailed jurisdiction-level information is available in Part 4. Variation between jurisdictions is evident, with 28 day readmission rates in 2010-11 being below 10% for the Australian Capital Territory (5%) and South Australia (9%). Within jurisdictions, there has been little movement over time except in the Australian Capital Territory where the rate has more than halved since 2005-06.

It should be noted that the estimates from some jurisdictions are more accurate than others. This is because accurate monitoring of 28 day readmission rates depends on a unique identifier information system that tracks the movement of people between hospitals. True readmission rates are likely to be underestimated in the absence of such a system, because a person who is discharged from one hospital and readmitted to another within 28 days will not be represented in the figures. In 2005-06, all jurisdictions except South Australia and Tasmania had such a system. Tasmania developed this capacity in 2007-08, but South Australia has not yet done so.

Considerable attention has been devoted to identifying ways of reducing readmission rates. For example, eight mental health services from around the country considered this issue when they participated in the National Mental Health Benchmarking Project, which began in 2005.

Representatives from these services used a combination of methods to identify positive practices in this area. They concluded that seamless provision of care across inpatient and ambulatory services is required to improve readmission rates, as are good discharge planning and proactive community follow up. They also emphasised good governance, and consumer and carer engagement across the continuum of care.⁵¹ Top of page

Figure 60: Percentage of admissions to state and territory acute inpatient units followed by a readmission within 28 days, 2005-06 to 2010-11

Text version of figure 60

Percentage of admissions:

• 2005-06 - 15.5%
• 2006-07 - 15.1%
• 2007-08 - 15.5%
• 2008-09 - 14.7%
• 2009-2010 - 14.1%
• 2010-11 - 14.7%