Trends in Patient Characteristics Associated with Preventable 30-day ER Readmissions

We will examine and improve the management of patients discharged from our hospital to skilled nursing facilities (SNF). We aim to identify patient characteristics, including cognitive impairment, mental health conditions, and social vulnerabilities, that are associated with potentially preventable 30-day hospital readmissions and ER revisits. Through real-time case review and targeted analysis, our goal is to detect trends in these preventable readmissions and identify strategies to enhance care coordination, address mental health needs, and reduce avoidable acute transfers among SNF patients.