Causes of readmissions for patients discharged on enteral nutrition

Patients discharged with enteral nutrition (EN) through an enteral access device (DCENs) are noted to have increased hospital readmissions, but data on the readmission causes are limited. We assessed the proportion of these readmissions attributed to EN and determined the contributing factors to readmissions.

Using electronic health record data, we conducted a retrospective cohort study of all hospital encounters in an academic, urban hospital from July 2017 to December 2019 with discharge with EN to find all unplanned readmissions at the same hospital within 90 days. For each readmission, we evaluated through chart review whether discharge documentation identified the primary cause of readmission to be EN-related and evaluated for EN-related plan adjustments upon discharge.

Over the 30-month period, there were 224 and 442 readmissions within 30 and 90 days for DCENs, respectively. EN-related readmissions accounted for 20.5% of 30-day readmissions and 16.7% of 90-day readmissions. Among these, 44.6% (33 of 74) documented enteral access device issues, 40.5% (30 of 74) cited gastrointestinal symptoms that the team attributed to EN, and 14.9% (11 of 74) cited sodium imbalance. The EN plan was changed in 97.3% (72 of 74) of EN-related readmissions and 32.3% (119 of 368) of EN-unrelated admissions. 52.0% of 90-day readmissions were within 90 days of initiating EN.

20.5% of readmissions for DCENs are related to EN, with 52.0% occurring within 90 days of initiating EN. Quality improvement interventions targeting postdischarge care may decrease hospital readmissions in this high-risk and medically complex patient population.