Table 3 Examples of patients with an unplanned hospital revisit related to an inadequate request for follow-up
Patient | Hospitalisation course | Request for follow-up | Unplanned revisit |
|---|---|---|---|
77 y, female Medical history: Heart failure, diabetes type 1, hypothyroidism, atrial fibrillation No. of medications at admission: 12 | Admitted to hospital for syncope and diagnosed with a brain tumour. Betamethasone and levetiracetam were started as a direct result of the tumour. The insulin dosage was increased. Major changes were made in the heart failure treatment because of complications; spironolactone and enalapril were withdrawn because of hyperkalaemia, and the bisoprolol dosage was decreased because of bradycardia. | The Neurosurgery and Endocrinology departments were requested to follow up the medication changes associated with the brain tumour and diabetes, but an MRR for the heart failure medication changes was not sent. | Readmitted to hospital due to worsening of heart failure and was restarted on spironolactone; candesartan and furosemide were prescribed, and the dosage of bisoprolol was increased. |
84 y, male Medical history: Previous myocardial infarction, renal failure, heart failure, hypertension, gout No. of medications at admission: 16 | Admitted to hospital with a myocardial infarction. Worsening of heart and renal failure were detected. Treatment with candesartan and other new medications for the myocardial infarction was initiated. The patient’s gout treatment was also optimised by changing prednisolone to low dose allopurinol 100 mg once daily. | The heart failure outpatient unit was requested to follow up the new cardiology medications, but an MRR for the changed gout treatment was not sent. | Readmitted to hospital with joint pain due to worsening of gout. |
82 y, female Medical history: Recent cerebral infarction with a subsequent hemiplegia and expressive aphasia No. of medications at admission: 6 | Admitted from a short-term nursing facility after post-stroke seizures. An anticonvulsant was started. The patient was expressing pain and anxiety. The fentanyl dosage was increased, oxycodone as needed and oxazepam were started. Laxative treatment with macrogol as needed was unchanged. | No follow-up of the medications was requested. The patient returned to the short-term nursing facility after discharge. | Revisited the emergency department with abdominal pain due to constipation, possibly related to the opioid treatment. |
91 y, male Medical history: Asthma, COPD, hypertension, dementia No. of medications at admission: 11 | Admitted with COPD exacerbation. Poor inhaler technique was identified, and the inhalers were switched from DPIs (budesonide/formoterol) to pMDIs (budesonide/formoterol). The patient had problems with swollen ankles, which was suspected to be related to felodipine. An MRR to the PCP to consider change of antihypertensive medication was planned. | No MRR was sent to follow up the new inhalers and the swollen ankles. | Readmitted with a new COPD exacerbation and worsening of the swollen ankles. |