HOSPITAL Score for Readmissions

HOSPITAL Score

H - Hemoglobin at Discharge <12 g/dL

O - Discharge from Oncology Service

S - Sodium <135 mEq/L at Discharge

P - Procedure During Hospital Stay (ICD-9 coded)

I - Index Admission Type (Non-Elective)

T - Number of Hospital Admissions in Prior Year

AL - Length of Stay ≥5 Days

Score:–

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Predicts 30-day potentially avoidable hospital readmissions.

Why Use

Internationally validated scoring system for predicting avoidable 30-day readmission risk. Incorporates readily available clinical and administrative data. Enables clinicians to identify high-risk patients, proactively address modifiable risk factors before discharge, and reduce costs. Helps improve hospital performance metrics and patient outcomes by reducing avoidable readmissions.

When to Use

Use in discharge and post-discharge planning to screen for patients at high risk of 30-day readmission.

Formula

Addition of the selected points: Variable Points Hemoglobin level at discharge, g/dL ≥12 0 <12 1 Discharged from oncology service No 0 Yes 2 Sodium level at discharge, mEq/L ≥135 0 <135 1 Any ICD-9 coded procedure performed during hospital stay No 0 Yes 1 Index admission type Elective 0 Urgent or emergent 1 Number of hospital admissions during the previous year 0-1 0 2-5 2 >5 5 Length of stay <5 days 0 ≥5 days 2

Pearls / Pitfalls

Specifically designed to identify potentially avoidable readmissions, rather than both avoidable and unavoidable readmissions. Does not account for non-medical factors, such as social determinants of health, which may significantly affect readmission risk.

Advice

Use this tool in combination with clinical judgment to guide discharge planning and post-discharge care. Consider other critical factors, such as social determinants of health, which may also influence a patient’s readmission risk. Higher-risk patients may benefit from: Optimization of medical conditions prior to discharge. Assigning additional case management and care transition services. Scheduling outpatient follow-up appointments and/or home health visits. Thorough medication reconciliation. Education on warning signs, at-home health management, and proper medication use.

More Information

Interpretation: HOSPITAL Score Risk Group Risk of Potentially Avoidable* 30-Day Readmission** 0-4 Low 5.8% 5-6 Intermediate 12.0% ≥7 High 22.8% *Algorithm used in Donzé et al classified “foreseeable” readmissions as avoidable , e.g. readmissions for transplantation, labor and delivery, chemotherapy, radiotherapy, follow-up, rehabilitation treatment, specific surgical procedures, or specific diseases deemed difficult to cure (e.g. multiple sclerosis, idiopathic thrombocytopenia). Then, readmissions involving new organ systems unknown to be affected during the preceding hospitalization were classified as unavoidable . Complications of treatment (e.g. DVT, catheter-associated UTI, drug-induced disorders) were considered potentially avoidable. **From Donzé 2016 (validation study).