After I was discharged from the Coronary Care Unit following my heart attack, I felt overwhelmed because, other than some reading material about heart-healthy eating and wound control, I was pretty well booted out the door with virtually no follow-up care plan once I got home.
So when my friend Viv’s daughter Kate phoned me a few days later (Kate happens to be a cardiac nurse), I had an endless list of panicky questions for her about my surprisingly distressing ongoing chest pains along with dozens of other issues. I was convinced that another heart attack was imminent – an extremely terrifying prospect for a freshly diagnosed heart patient. She was able to answer my questions (“Sounds like what we call post-stent stretching pain – very common!”) and reassured me that I just might live through another day.
Canadian researchers in Ottawa have developed a simple tool for hospital staff to predict the probability that patients like me, discharged directly from hospital back to the community, will be readmitted – or die – within 30 days.
The study, published in the Canadian Medical Association Journal, could help identify patients who may benefit from closer monitoring and care so that serious health problems can be prevented.
The tool was developed by a group of Canadian researchers led by Dr. Carl van Walraven of the Ottawa Hospital Research Institute, the University of Ottawa and the Institute for Clinical Evaluative Sciences.
The group examined detailed medical records from 4,812 people discharged from 11 Ontario hospitals, and found that four factors could predict the risk of re-admission or even death. They called the tool LACE to coincide with the factors, which are:
- Length of stay in hospital
- Acuity of the admission (whether or not it was through the emergency department)
- Comorbidity of the patient (a score based on what chronic diseases the patient has)
- Emergency room utilization (number of visits in the previous six months)
For example, let’s say you are a person with multiple chronic disease diagnoses like diabetes, heart disease and severe asthma. One night, you’re brought into your local hospital’s Emergency Department by ambulance with unusual chest pressure and extreme weakness – your third ambulance ride to Emergency in as many months. You undergo a number of tests this time, but are discharged within a day or two.
Each of these four LACE factors is assigned a number of points based on its value. When these points are added together, they form your total LACE score.With a possible LACE score of 19 points (the highest), medical staff now know that you have a 44% chance of re-admission to hospital or death.
Researchers found that people with a score of zero had only a 2% risk of re-admission or death.
The researchers obtained similar results when testing the LACE tool using records from 1 million Ontario hospital patients discharged between 2004 and 2008, as Dr. van Walraven explained:
“Our hospitals provide exceptional care, but many patients still face serious health challenges in the weeks following a hospital discharge. This research is an important step towards identifying those who are most at risk, so that we can address their health problems earlier and prevent serious complications.”
This study is part of a larger program that is using Ontario health records to find novel ways to improve health.
NOTE FROM CAROLYN: I wrote more about hospital stays and discharge planning in my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University, 2017). You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon. If you order it directly from Johns Hopkins University Press, you can use their code HTWN to save 20% off the list price.
Q: Have you ever left the hospital without a discharge plan?