Discharge and unscheduled readmissions of adult patients undergoing hematopoietic stem cell transplantation: implications for developing nursing interventions

Abstract

Purpose/objectives: To describe discharge and unscheduled readmission patterns of adult patients undergoing hematopoietic stem cell transplantation (HSCT). To identify implications for nursing practice from survey results and the literature that may improve patient outcomes during and following initial hospital discharge.

Design: Retrospective chart review and literature review.

Setting: National Cancer Institute-designated Comprehensive Cancer Center.

Sample: 100 adult patients undergoing HSCT in the first six months of 2000.

Methods: Investigator-created retrospective chart-review tool collected data in three areas: demographic, clinical, and readmissions in the first six months after discharge.

Main research variables: Demographic variables: gender, marital status, age, and diagnosis; clinical variables: remission status at transplant, type of transplant, presence of comorbid or concurrent conditions, number of infections, number of catheter-related infections, number of bacteremic episodes, and psychosocial support; readmission variables: reason for admission, discharge or death data, number of days of each admission, and length of time between discharge to the next admission.

Findings: Fifty-one percent had at least one unscheduled readmission, and 80% developed an infection after HSCT. Further analysis comparing autologous to allogeneic transplant recipients indicated that the allogeneic group had a higher number of readmissions, unscheduled readmissions, and infections. Patients who reported an infection within a month prior to HSCT had a 50% mortality rate after transplantation.

Conclusions: Findings indicate that allogeneic transplant recipients are a more vulnerable population in regard to infections and readmissions. Developing and testing nursing interventions surrounding the discharge period are needed next steps in improving care.

Implications for nursing: Knowledge of trends in this vulnerable population will guide nursing to plan targeted interventions.