High Readmission Rate in a Patient With Chronic Heart Failure, End-Stage Renal Disease, and Chronic Pulmonary Obstructive Disease.

Hospital readmission is common for patients with multiple chronic comorbidities, but it is a burden to both patients and healthcare systems. While this is a multifactorial issue, it is important to identify some of the reasons that contribute to high readmission rates and advocate for concrete interventions that can be implemented. We report the case of a 68-year-old female with congestive heart failure with severely reduced ejection fraction, chronic obstructive pulmonary disease requiring home oxygen, and end-stage renal disease on hemodialysis who was readmitted more than 30 times in the previous year. In the last readmission, the patient was admitted for acute on chronic respiratory failure, which improved with hemodialysis during the hospital stay. Beyond her complex comorbidities, the patient's recurrent admissions were further complicated by restricted mobility, limited home health aid hours, and treatment noncompliance. Strategies such as consistent professional interpreter use, patient-specific medical education, pharmacy delivery programs, and medically adapted transportation may help reduce hospitalizations. The causes of high readmission rates are multifactorial. This case highlights numerous techniques to increase patient compliance and thereby reduce readmissions. Patient-centered strategies, combined with system-level improvements, are needed to address the complexities faced by patients with multiple comorbidities. Further research is needed to identify additional strategies that reduce readmissions, improve quality of life, and lower morbidity and mortality.