Incidence Rates, Causes and Strategies to Prevent Hospital Readmissions at National Hospital Galle, Sri Lanka

Incidence Rates, Causes and Strategies to Prevent Hospital Readmissions at National Hospital Galle, Sri Lanka | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidence Rates, Causes and Strategies to Prevent Hospital Readmissions at National Hospital Galle, Sri Lanka Payas A.L.M, Abeyrathne S.L.D.W, Bandara Thushari, Fernando G.H.S, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9146946/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background: A readmission is defined as an unplanned subsequent hospital admission in the same or a different hospital within 30 days after discharge from hospital due to the same illness. Readmission rates and its causative factors could be used to measure the quality of health care and accountability. Present study was undertaken to determine the incidence and causative factors of hospital readmissions at National Hospital Galle, Sri Lanka and to study the ongoing strategies for their prevention. Methods: This is a descriptive cross-sectional study. A pre-tested interviewer-administered questionnaire was used to collect data from re-admitted patients for consecutive seven days. Further data were collected from nursing officers (n=102) who are participated in the patient discharge process at the same hospital to assess the strategies to prevent re-admissions. Data were analyzed using SPSS version 25.0, by using descriptive statistics, Pearson’s test and Chi-square tests wherever applicable. Results: This study assessed seven-day hospital readmissions among 4,492 patients admitted to the National Hospital Galle. A total of 946 patients were readmitted, during the study period giving an overall readmission rate of 21.06%. Most readmissions were planned (19.08%), while 1.98% were unplanned. Elderly patients (≥65 years) and those with multiple chronic conditions, including diabetes, hypertension, and heart failure, had higher readmission rates. Patients discharged within five days showed an increased risk of readmission. Readmitted patients reported lower satisfaction, particularly regarding communication and discharge instructions. Nursing staff surveys revealed dissatisfaction with discharge processes, inadequate patient education, limited post-discharge follow-up, and insufficient time and training for discharge counselling Conclusions: Findings concluded that, general readmission rate of NHG is 21.06% and unplanned readmission rate is 1.98%. The readmissions were significantly influenced by patients' dissatisfaction with post-discharge support and discharge communication, underscoring the need for improved patient education and follow-up. Incidence rate Hospital readmission Causative factors Preventive strategies Background Hospital readmission, commonly defined as an unplanned admission to the same or a different hospital within 30 days following discharge for the same condition, is widely recognized as an important indicator of healthcare quality and continuity of care [ 1 ]. High readmission rates are associated with increased healthcare costs, overcrowding of hospitals, and adverse patient outcomes, including physical, psychological, and social burdens [ 2 ]. Consequently, reducing avoidable hospital readmissions has become a priority for healthcare systems worldwide. International evidence indicates that a significant proportion of readmissions are preventable and often result from inadequate discharge planning, poor patient education, limited follow-up care, medication non-adherence, and socio-economic constraints [ 3 , 4 ]. Elderly patients and individuals with chronic diseases such as diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and mental health disorders are particularly vulnerable to repeated hospitalizations [ 5 , 6 ]. Short hospital stays and insufficient post-discharge support further increase the risk of unplanned readmissions [ 7 ]. Nurses play a pivotal role in preventing hospital readmissions through comprehensive discharge planning, patient and family education, medication reconciliation, and coordination of post-discharge care [ 8 ]. Evidence suggests that nurse-led interventions, including structured discharge protocols, follow-up calls, and community-based support, can significantly reduce readmission rates and improve patient outcomes [ 9 , 10 ]. However, the effectiveness of these strategies depends on institutional support, availability of resources, and consistent implementation. Despite extensive international research, there is a notable lack of empirical evidence on hospital readmission rates, associated factors, and preventive strategies within the Sri Lankan healthcare context. Limited local studies highlight gaps in discharge education, follow-up mechanisms, and community support systems [ 11 ]. Understanding the incidence, causes, and existing preventive practices of hospital readmissions at the National Hospital Galle is therefore essential to inform targeted interventions, improve quality of care, and support evidence-based policy development. Methods A descriptive cross-sectional study design was utilized to comprehensively evaluate the incidence of hospital readmissions, examine patient- and hospital-related contributing factors, and assess strategies aimed at preventing readmissions at the National Hospital Galle located in Southern Sri Lanka. This is the third largest tertiary care center in Sri Lanka, delivers specialized medical, surgical, pediatric, and psychiatric services and functions as a major referral center for the region. The study was conducted from April 30 to 07 May in 2025. The population of the study was the patients who were admitted more than one time within 30 days for same disease condition to National Hospital Galle and nursing officers who working in medical wards, surgical wards, pediatrics wards and psychiatric wards involving in discharge procedure in National Hospital Galle. The study population consisted of two main groups: patients who experienced unplanned readmission within 30 days following discharge for the same clinical condition and nursing officers who were directly involved in discharge planning, patient education, and continuity of care are eligible for this study. Patients admitted for oncology and dialysis units were excluded because their readmissions are typically scheduled as part of long-term treatment protocols. As well as Nurses who were leave on during study period and nurses who were not willing to participate in the study were excluded from this study. The required sample size for the patient group was calculated using the incidence rate formula proposed by Lwanga and Lemeshow, resulting in a minimum sample of 67 participants. Data collection was conducted over a continuous seven-day period, during which all eligible patients meeting the inclusion criteria were recruited through consecutive sampling method and a total of 89 unplanned readmission cases. For the nursing officer component, the sample size was determined using the finite population correction formula, which indicated a minimum requirement of 102 participants. A stratified random sampling technique was employed to ensure proportional representation of nursing officers from different wards and clinical units within the hospital. Data were collected using two structured, pre-tested questionnaires specifically developed for this study, by the investigators. An interviewer-administered questionnaire was used for patients and comprised 57 items designed to gather detailed information on socio-demographic characteristics, medical history, comorbid conditions, previous hospitalizations, discharge planning experiences, medication instructions, follow-up arrangements, and circumstances surrounding readmission. A self-administered questionnaire was used for nursing officers and included 61 items across ten domains addressing discharge planning practices, patient education, medication reconciliation, coordination of multidisciplinary care, communication methods, and strategies implemented to reduce preventable readmissions. The development of both questionnaires was guided by an extensive review of relevant literature and clinical guidelines and was made available in Sinhala, Tamil, and English to ensure participant comprehension. Eligible readmitted patients were identified on a daily basis using the hospital information management system and admission records. Interviews were conducted in the respective wards at times that were convenient for the patients and did not interfere with clinical care. Nursing officers were approached during duty hours, provided with information regarding the study objectives, and invited to participate. Questionnaires were distributed after obtaining written informed consent and were collected either on the same day or within an agreed period to minimize disruption to routine duties. To ensure the quality, reliability, and clarity of the data collection tools, a pre-test was conducted among ten patients and ten nursing officers in a comparable healthcare setting. Feedback obtained during the pre-testing phase was used to refine question wording, structure, and sequencing. Data collected at a p-value of less than 0.05. Results of the 1st part The overall 30-day readmission incidence rate was 21.06% (946 patients). This includes 19.08% (857 patients) of planned readmissions and 1.98% (89 patients) unplanned readmissions. These rates correspond to approximately, 21 planned readmissions per 100 patients weekly or 210 per 1,000 patients weekly and 2 unplanned readmissions per 100 patients weekly or 20 per 1,000 patients weekly. Summary of readmission incidence rate was indicated in Table 1 . Table 1 Summary of Readmission Data (One-Week Study Period) (n = 4492) Category Number of Patients Percentage of Total (n = 4492) Total admissions assessed 4,492 100% Admissions not within 30 days 3,417 76.07% Initial 30-day admissions identified 1,075 23.93% Confirmed readmissions – Planned readmissions – Unplanned readmissions 946 21.06% 857 19.08% 89 1.98% Non-readmissions (excluded) 120 2.67% Untraceable patients 9 0.20% Approximately 3428 planned readmissions per month and 44564 planned readmissions per year occur in National Hospital Galle. As well as, approximately 356 unplanned readmissions per month and 4628 planned readmissions per year occur in National Hospital Galle. Estimated projection for month and year indicated in Table 2 . Table 2 Estimated projections (Extrapolated from Weekly Data) Readmission Type Weekly Incidence Monthly Estimate Annual Estimate Planned 857 3,428 44,564 Unplanned 89 356 4,628 The present study involved a group of 89 patients. The gender distribution showed a higher proportion of males (55.1%) than females (44.9%). Age distribution skewed towards the elderly, with 38.2% of patients aged over 60 years and only 13.5% below 20 years. This aligns with literature indicating that older adults are more prone to readmissions due to co morbidities and functional limitations. A substantial majority of patients were married (76.4%) and Sinhala (93.3%), reflecting regional population patterns. The predominant religion was Buddhism (89.9%). Educational attainment was relatively low, with 15.7% never attending school and 38.2% having only primary-level education. Notably, 59.6% of participants were unemployed, and 39.3% had no source of income, suggesting that socioeconomic vulnerability may play a role in post-discharge challenges. To better understand the social demographic characteristics of these patients, their information was compiled and presented in Table 3 . Table 3 Socio-demographic characteristics of the re-admitted patients (n = 89) Count Column N % Gender Female 40 44.9% Male 49 55.1% Age group 60 34 38.2% Marital status Married 68 76.4% Unmarried 19 21.3% Separated 0 0.0% Divorced 0 0.0% Widowed 2 2.2% Nationality Sinhala 83 93.3% Muslim 3 3.4% Tamil 3 3.4% Burgher 0 0.0% Other 0 0.0% Religion Buddhism 80 89.9% Christianity 3 3.4% Islamic 3 3.4% Hindu 3 3.4% Other 0 0.0% Educational status Not schooling 14 15.7% Grade 5 34 38.2% O/L 14 15.7% O/L Pass 15 16.9% A/L 7 7.9% A/L Pass 4 4.5% Graduate 1 1.1% Employment status Yes 36 40.4% No 53 59.6% Monthly income No income 35 39.3% 100000 0 0.0% Table 4 summarizes patient-related factors associated with unplanned readmissions (n = 89). A majority of patients reported very good understanding of discharge instructions (67.4%) and health education (66.3%), and a similar proportion took medications without missing doses (67.4%). Follow-up-related challenges were reported by 52.8% of patients. Although most patients demonstrated concern about their health (84.3%), adequate home support (94.4%), and preparedness for home care (89.9%), adherence to nutrition education was relatively low, with only 22.5% fully following recommended dietary advice. Overall, the findings suggest that while general discharge understanding and support systems were strong, gaps in follow-up and nutritional adherence may have contributed to readmissions. Table 4 Patients Related Factors for readmissions . Patient-Related Factors Number of patients (n = 89) Percentages (%) Understood Discharge (Very Well) 60 67.4 Follow-up Issues (Yes) 47 52.8 Took Medicines Without Missing 60 67.4 Understood Health Education (Very Well) 59 66.3 Followed Health Education (Yes) 55 61.8 Understood Nutrition Education (Very Well) 40 44.9 Followed Nutrition (Fully) 20 22.5 Prepared for Home Care 80 89.9 Adequate Home Support 84 94.4 Able to Follow-Up (Always + Most) 71 (30 + 41) 79.8 Concern About Health (Yes) 75 84.3 Table 5 shows how hospital care and discharge processes were experienced by the 89 patients who were readmitted. Most patients felt that the basic steps were done properly before discharge. Almost all patients were given discharge instructions (91%) and information about their medications (92.1%). A large proportion were also told to attend follow-up clinics (85.4%) and received some form of health education (78.7%) and nutrition advice (74.2%). This indicates that routine discharge communication was generally provided. Despite this, important gaps were identified in areas that directly support patients after going home. Only a small number of patients (18%) received a written care plan, which means many had to rely on memory or verbal instructions alone. In addition, less than half of the patients (43.8%) felt that their follow-up care was very satisfactory, suggesting problems with continuity of care after discharge. Teaching on how to manage medical devices was particularly poor, with only 9% receiving such instructions, placing these patients at higher risk of complications once they returned home. Most patients (77.5%) stayed in hospital for only 1–3 days. While short hospital stays are often necessary, they may reduce the time available for detailed patient education and discharge planning. Although over half of the patients described their overall hospital experience as excellent (53.9%) and many felt well supported by the healthcare team (76.4%), these positive experiences did not always lead to smooth recovery after discharge. Table 5 Hospital Related Factors for Readmissions Hospital Related factors Number of patients (n = 89) Percentages (%) Received Discharge Instructions 81 91 Told to Attend Follow-Up 76 85.4 Instructed About Medications 82 92.1 Instructed About Health Education 70 78.7 Instructed About Nutrition 66 74.2 Instructed to Manage Devices 8 9 Hospital Stay 1–3 Days 69 77.5 Overall Hospital Experience (Excellent) 48 53.9 Support from Healthcare Team (Very Supported) 68 76.4 Received Written Care Plan 16 18 Follow-Up Care Very Satisfactory 39 43.8 Results of the 2nd Part Table 6 presents the socio-demographic characteristics of the nurses who participated in the study (n = 102). The mean age of the respondents was 38 years, with an age range of 28 years and a standard deviation of 7, indicating a predominantly middle-aged nursing workforce. The sample was largely female, with 95 nurses (93.1%), while only 7 participants (6.9%) were male, reflecting the female predominance commonly observed in the nursing profession. With regard to ethnicity, the majority of respondents were Sinhalese (98.0%, n = 100), whereas a small proportion belonged to Christianity (2.0%, n = 2). In terms of professional experience, nurses had a mean of 12 years of service, with a wide range of experience spanning up to 34 years and a standard deviation of 7, suggesting a mix of moderately experienced and highly experienced nurses in the study setting. Concerning professional position, most participants were Nursing Officers (79.4%, n = 81). This was followed by Nursing Officer Grade I (15.7%, n = 16). A smaller number of respondents held senior positions, including Nursing Officer Grade II (2.0%, n = 2), Nursing Officer Grade III (2.0%, n = 2), and Nursing Sister (1.0%, n = 1). Overall, the table indicates that the study sample consisted mainly of experienced female nursing officers, providing a relevant perspective on hospital practices related to patient care and readmission prevention. Table 6 Socio-demographic characteristics of the nursing officers (n = 102) Age Count Column N % Mean Range Standard Deviation 102 100.0% 38 28 7 Gender Female 95 93.1% Male 7 6.9% Ethnicity Christianity 2 2.0% Sinhalese 100 98.0% Experience years 102 100.0% 12 34 7 Position Nursing officer 81 79.4% Nursing officer-Grade I 16 15.7% Nursing officer-Grade II 2 2.0% Nursing officer -Grade III 2 2.0% Nursing Sister 1 1.0% Table 7 presents the strategies currently used by nurses to prevent hospital readmissions. The findings show that nurses are actively involved in multiple preventive practices across readmission tracking, discharge planning, medication management, patient education, follow-up care, training, and patient engagement. Regarding readmission tracking, the most commonly used method was manual tracking, reported by 51 nurses (50.0%), followed by electronic health record (EHR) tracking used by 33 nurses (32.4%). In contrast, the use of standard protocols (10.8%), informal or personal methods (6.9%), and diagnosis cards or clinic books (1.0%) was relatively low, indicating limited reliance on structured or standardized tracking systems. In terms of discharge planning, patient education at discharge was the most frequently practiced strategy, reported by 71 nurses (69.6%). Planning for high-risk patients was also commonly implemented (52.9%), while discharge checklist use was reported by 38.2% of nurses. These findings highlight the emphasis placed on education-based discharge processes, though checklist-based approaches were less consistently applied. With respect to medication management, double-checking medications was the most widely used strategy (60.8%), followed by medication reconciliation (56.9%) and clarifying medication instructions (53.9%). This suggests a strong focus on medication safety practices aimed at reducing medication-related readmissions. Concerning patient education, verbal education was provided by 59.8% of nurses, while nutrition and lifestyle education was reported by 51.0%. Written educational materials were less frequently used (45.1%), indicating a greater reliance on verbal communication rather than written resources. In the area of follow-up care, only 26.5% of nurses reported arranging post-discharge phone calls, and home visits after discharge were reported by just 8.8% of nurses. This demonstrates limited post-discharge follow-up practices, which may contribute to higher readmission risk. Regarding training and support, lack of training was reported by a substantial proportion of nurses (60.8%), while only 38.2% indicated that they had received training related to readmission prevention, suggesting a notable gap in professional development. Finally, under patient engagement and communication, patient involvement in discharge planning was reported by 47.1% of nurses. Collaboration with family members (44.1%) and communication with caregivers (46.1%) were moderately practiced, indicating partial but inconsistent engagement of support systems in the discharge process. Table 7 – Currently use strategies to prevent hospital readmissions Category Preventive Strategies Number of Nurses Percentages (%) Readmission Tracking Manual tracking 51 50 EHR tracking 33 32.4 Standard protocols 11 10.8 Informal/personal methods 7 6.9 Diagnosis card/clinic books 1 1 Discharge Planning Patient education on discharge 71 69.6 Planning for high-risk patients 54 52.9 Discharge checklist use 39 38.2 Medication Management Double-check medications 62 60.8 Medication reconciliation 58 56.9 Clarify medication instruction 55 53.9 Patient Education Verbal education 61 59.8 Written materials 46 45.1 Nutrition/lifestyle education 52 51 Follow-Up Care Post-discharge phone calls 27 26.5 Home visits after discharge 9 8.8 Training & Support Received training 39 38.2 Felt lack of training 62 60.8 Patient Engagement & Communication Patient involvement in discharge 48 47.1 Collaboration with family 45 44.1 Communication with caregivers 47 46.1 Discussion The findings revealed that the overall 30-day readmission rate was 21.06%, of which 19.08% were planned readmissions and only 1.98% were unplanned readmissions. This indicates that more than 90% of all readmissions were planned, highlighting a distinctive readmission pattern at NHG when compared with international healthcare settings [ 1 , 2 ]. Globally, reported 30-day readmission rates vary considerably. A large systematic review conducted in China reported an overall readmission rate of 7.6%, including 6.7% planned and 0.9% unplanned readmissions [ 3 ]. In contrast, studies from Hong Kong and Australia have reported unplanned readmission rates of 16.7% and 7.4%, respectively [ 4 , 5 ]. While the total readmission rate at NHG (21.06%) is comparable to rates reported from other tertiary hospitals, the proportion of planned readmissions (19.08%) is markedly higher. This finding may be explained by the hospital’s role as a tertiary referral center, where patients frequently require repeated admissions for scheduled procedures, long-term therapies, and follow-up interventions [ 6 ]. The unplanned readmission rate of 1.98% observed in this study is substantially lower than the 5–20% range reported internationally [ 7 , 8 ]. However, this low rate should be interpreted with caution. Oncology and dialysis units were excluded from the study, despite these units accounting for a significant proportion of unplanned readmissions in other settings. In addition, the short study period may have contributed to underestimation. Therefore, the low unplanned readmission rate may reflect methodological limitations rather than superior quality of care [ 2 , 7 ]. Patient-related factors were found to play an important role in readmissions. The elderly population accounted for a higher proportion of readmitted patients, particularly those aged 65 years and above, consistent with global evidence that aging populations are at increased risk of hospital readmission [ 5 , 9 , 10 ]. Furthermore, patients with multiple chronic conditions such as diabetes, hypertension, and heart failure showed a significantly higher likelihood of readmission [ 11 ]. Shorter hospital stays were also associated with increased readmission risk, with patients discharged within five days more frequently returning to hospital, suggesting possible premature discharge or inadequate stabilization [ 12 ]. Discharge-related factors emerged as major contributors to readmissions. Although patients reported overall satisfaction with inpatient care, only 18% of patients received a written discharge care plan, indicating a substantial gap in structured discharge communication [ 13 ]. Additionally, 30% of patients did not adhere to dietary recommendations after discharge, highlighting deficiencies in patient understanding and follow-through [ 13 , 14 ]. These findings align with international literature identifying poor discharge education and inadequate communication as major drivers of preventable readmissions [ 6 , 15 , 16 ]. The nursing officers’ perspective further reinforced these findings. More than two-thirds of nurses reported dissatisfaction with current discharge processes, and only a minority confirmed routine post-discharge follow-up such as phone calls or home visits [ 17 , 18 ]. Medication reconciliation was reported as always performed by only 41.0% of nurses, while 34.4% indicated it was done only sometimes, increasing the risk of medication errors after discharge [ 19 ]. Additionally, only 29.5% of nurses reported regular involvement of a multidisciplinary team in discharge planning, and just 16.4% confirmed the use of electronic systems to track discharged patients or coordinate follow-up care [ 20 , 21 ] Limitations of the study This research was carried out in only one therefore the results may not necessarily indicative of what is going on generally in other hospitals in Sri Lanka. Information collected through self-administered questionnaire may carry recall bias. Further, as information was gathered within a short time window, so it may not reflect seasonal or festival-related variation in readmission trends. Conclusions and recommendations This study analyzed readmission in the National Hospital Galle and explored the reasons behind it, both the hospital and patient factors. It also assessed what was being done to prevent readmission of patients. The results showed that while the unplanned readmission rate was 1.98%, a significant percentage-21%-were planned. These statistics, though not unusually high, emphasize that readmission is still an ongoing concern and one that needs more focus. From the patient side, older age, multiple health conditions, and low satisfaction with care were more commonly seen in those who were readmitted. On the hospital side, gaps in discharge planning, follow-up care, and multidisciplinary teamwork were evident. Although most nurses reported giving discharge instructions (91.8%), only 36.1% said there was regular follow-up after discharge. Medication reconciliation and digital health systems were also not consistently used. Compared to what other nations practice, there is no doubt that some of the good strategies are being implemented while others-such as post-discovery calls at regular intervals, having the input of pharmacists, and through electronic records-are not being fully utilized. In conclusion, the study illustrates that improving the process of preparing the patient for discharge from and follow-up after hospital discharge could help reduce avoidable readmissions. The findings reveal sensible things that are possible to emphasize from the hospital to promote care and decongest patients and the health system. Abbreviations □ AMI Acute Myocardial Infarction □ COPD Chronic Obstructive Pulmonary Disease □ CVD Cardiovascular disease □ HBSNFs Hospital-based Skilled Nursing Facilities □ HRRP Hospital Readmission Reduction Program □ LTDs Long-Term Chronic Diseases □ NHG National Hospital Galle □ NIMH National Institute of Mental Health □ PCPs Primary Care Physician □ SSHs Short-Stay Hospitalizations □ UK United Kingdom □ USA United States of America Declarations Ethics approval and consent to participate - The ethical approval for the proposed study was sought from the Ethics Review Committees of the Faculty of Allied Health Sciences, University of Ruhuna before the commencement of the study (Reference No – 2024.09.463), in accordance with the Declaration of Helsinki. Informed written consent was obtained from all participants before their enrolment in the study. Consent for publication - Not applicable. Manuscript does not contain any individual person’s data. Availability of data and materials - The data that support the findings of this study are available from the corresponding author, upon reasonable request. Competing interests : None Funding : None Authors' contributions : Payas A.L. M, Abeyrathne S.L.D. W, Thushari Bandara, Fernando G.H. S and Ranga Sabapathige confirm the sole responsibility for study conception and design, data collection, analysis, interpretation of results, and manuscript preparation. Acknowledgement We are thankful to the Director of National Hospital Galle for granting permission and facilitating this study. Our appreciation also extends to the nursing officers and patients who willingly participated in this research Authors' information Prof. (Mrs.) W.V.R.T.D.G. Bandara, Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna Sri Lanka Abdul Lathif Mohamad Payas, Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna. Samarappulige Lakshani Dinithi Wimansa Abeyrathne, Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna Dr. Fernando GHS, Director, District General Hospital, Matale, Sri Lanka Dr. Ranga Sabapathige, Director, National Hospital Galle, Sri Lanka References Ministry of Health, Nutrition and Indigenous Medicine. Guideline reporting readmission. Colombo: Government of Sri Lanka; 2013. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–28. Glans M, Borgström Bolmsjö B, Jakobsson U. Risk factors for 30-day hospital readmission among older adults: a systematic review. Int J Older People Nurs. 2020;15:e12256. Yam CHK, Wong ELY, Cheung AWL, Chan FWK, Wong FYY, Yeoh EK, et al. Avoidable readmission in Hong Kong—systematic review. BMC Health Serv Res [Internet]. 2010 [cited 2025 Oct 18];10:311. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-10-311 Considine J, Berry D, Newnham H. Factors associated with unplanned hospital readmissions: an Australian retrospective cohort study. BMJ Open [Internet]. 2019 [cited 2025 Oct 18];9:e024941. Available from: https://bmjopen.bmj.com/content/9/4/e024941 Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822–28. Anderson GF, Steinberg EP. Hospital readmissions in the Medicare population. N Engl J Med. 1984;311:1349–53. Boutwell A, Hwu S. Effective interventions to reduce rehospitalizations: a survey of the published evidence. Cambridge: Institute for Healthcare Improvement; 2009. Jahnigen DW, Hannon C, Laxson L, LaForce FM. Hospital readmission in the elderly: relationships among demographic, social, and clinical predictors. J Am Geriatr Soc. 1982;30:433–37. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613–20. Abesekara P, Perera A, Wijesinghe S. Predictors of readmission among patients with mental illnesses at the National Institute of Mental Health, Sri Lanka. Sri Lanka J Psychiatry. 2018;9:15–21. Pergeline A, Le Fur S, Monnier A, Duguet A, Zureik M, Huas D. Short-stay hospitalizations and readmissions in children with long-term diseases. Arch Pediatr. 2023;30:144–52. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150:178–87. Carter J. Factors affecting patient readmissions within 30 days: a patient perspective. J Healthc Qual. 2019;41:222–30. Bamforth L, Williams P, Jackson D. Preventing hospital readmissions: patient and nurse perspectives. J Clin Nurs. 2021;30:976–85. Adamuz J, Vázquez-Sánchez MÁ, González-Ramírez M. Role of nurses in reducing readmissions: a systematic review. Int J Nurs Stud. 2021;123:104046. Herzig SJ, Schnipper JL, Doctoroff L, Mathew C, Shieh MS, Burgess JD, et al. Hospital and primary care physicians' perspectives on hospital readmissions: a national survey. J Hosp Med. 2016;11:162–67. Gupta A, Singh K, Patel S. Nursing interventions in reducing hospital readmission: a review. Nurs Outlook. 2024;72:43–50. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–67. Häyrinen K, Saranto K, Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform. 2008;77:291–304. Vest JR, Gamm LD. Health information exchange: persistent challenges and new strategies. J Am Med Inform Assoc. 2010;17:288–94. Additional Declarations No competing interests reported. Supplementary Files Questionnaires.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 13 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviews received at journal 08 Apr, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviewers agreed at journal 03 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers invited by journal 30 Mar, 2026 Editor assigned by journal 30 Mar, 2026 Editor invited by journal 27 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 27 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9146946","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":614727612,"identity":"6b3e10ab-ccff-4123-9625-24b8f099f174","order_by":0,"name":"Payas A.L.M","email":"","orcid":"","institution":"University of Ruhuna","correspondingAuthor":false,"prefix":"","firstName":"Payas","middleName":"","lastName":"A.L.M","suffix":""},{"id":614727613,"identity":"a759b47d-11a5-4e37-b99c-48c68d6521a1","order_by":1,"name":"Abeyrathne S.L.D.W","email":"","orcid":"","institution":"University of Ruhuna","correspondingAuthor":false,"prefix":"","firstName":"Abeyrathne","middleName":"","lastName":"S.L.D.W","suffix":""},{"id":614727614,"identity":"f0466e1d-df22-442b-a1e2-3c1939feeba8","order_by":2,"name":"Bandara Thushari","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYHACNiA+IMfAwEO0DmawFmPStSQ2EK3F4Eb+scc8f+6kbzh+9uCDDwx2croNBLUksxvztj3L3XAmL9lwBkOysdkBAlrMzhxmk+ZtOJy74UCOmTQP0IXbiNLC8+dwusH5N8RqOd4M1MJ2OMHgBrG22B9vNpOc23bYcOaNN8aGMwyI8ItkM+MziTd/Dsvznc8xfPChwk6OoBY4UACrNCBWOQjIN5CiehSMglEwCkYUAADkWEP5KMPGwwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Ruhuna","correspondingAuthor":true,"prefix":"","firstName":"Bandara","middleName":"","lastName":"Thushari","suffix":""},{"id":614727615,"identity":"08c50aea-4d0d-4354-baee-5af2e590ef5d","order_by":3,"name":"Fernando G.H.S","email":"","orcid":"","institution":"District General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"","lastName":"G.H.S","suffix":""},{"id":614727616,"identity":"5bdc760f-f027-4d09-8066-0fafdeb68ff0","order_by":4,"name":"Ranga Sabapathige","email":"","orcid":"","institution":"District General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ranga","middleName":"","lastName":"Sabapathige","suffix":""}],"badges":[],"createdAt":"2026-03-17 09:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9146946/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9146946/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105888224,"identity":"da6fbb52-dd94-45a1-b9d5-452ed16ca5ea","added_by":"auto","created_at":"2026-04-01 07:43:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":889080,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9146946/v1/35848913-4a17-4079-a9ee-6adf692aebe3.pdf"},{"id":105888199,"identity":"c3e5f7ac-ce8a-48fd-a21a-faee346b176c","added_by":"auto","created_at":"2026-04-01 07:43:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":194944,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaires.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9146946/v1/9645b4dbad612726c477a74a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eIncidence Rates, Causes and Strategies to Prevent Hospital Readmissions at National Hospital Galle, Sri Lanka\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eHospital readmission, commonly defined as an unplanned admission to the same or a different hospital within 30 days following discharge for the same condition, is widely recognized as an important indicator of healthcare quality and continuity of care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. High readmission rates are associated with increased healthcare costs, overcrowding of hospitals, and adverse patient outcomes, including physical, psychological, and social burdens [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Consequently, reducing avoidable hospital readmissions has become a priority for healthcare systems worldwide.\u003c/p\u003e \u003cp\u003eInternational evidence indicates that a significant proportion of readmissions are preventable and often result from inadequate discharge planning, poor patient education, limited follow-up care, medication non-adherence, and socio-economic constraints [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Elderly patients and individuals with chronic diseases such as diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and mental health disorders are particularly vulnerable to repeated hospitalizations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Short hospital stays and insufficient post-discharge support further increase the risk of unplanned readmissions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNurses play a pivotal role in preventing hospital readmissions through comprehensive discharge planning, patient and family education, medication reconciliation, and coordination of post-discharge care [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Evidence suggests that nurse-led interventions, including structured discharge protocols, follow-up calls, and community-based support, can significantly reduce readmission rates and improve patient outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the effectiveness of these strategies depends on institutional support, availability of resources, and consistent implementation.\u003c/p\u003e \u003cp\u003eDespite extensive international research, there is a notable lack of empirical evidence on hospital readmission rates, associated factors, and preventive strategies within the Sri Lankan healthcare context. Limited local studies highlight gaps in discharge education, follow-up mechanisms, and community support systems [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Understanding the incidence, causes, and existing preventive practices of hospital readmissions at the National Hospital Galle is therefore essential to inform targeted interventions, improve quality of care, and support evidence-based policy development.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA descriptive cross-sectional study design was utilized to comprehensively evaluate the incidence of hospital readmissions, examine patient- and hospital-related contributing factors, and assess strategies aimed at preventing readmissions at the National Hospital Galle located in Southern Sri Lanka. This is the third largest tertiary care center in Sri Lanka, delivers specialized medical, surgical, pediatric, and psychiatric services and functions as a major referral center for the region. The study was conducted from April 30 to 07 May in 2025. The population of the study was the patients who were admitted more than one time within 30 days for same disease condition to National Hospital Galle and nursing officers who working in medical wards, surgical wards, pediatrics wards and psychiatric wards involving in discharge procedure in National Hospital Galle.\u003c/p\u003e\n\u003cp\u003eThe study population consisted of two main groups: patients who experienced unplanned readmission within 30 days following discharge for the same clinical condition and nursing officers who were directly involved in discharge planning, patient education, and continuity of care are eligible for this study. Patients admitted for oncology and dialysis units were excluded because their readmissions are typically scheduled as part of long-term treatment protocols. As well as Nurses who were leave on during study period and nurses who were not willing to participate in the study were excluded from this study.\u003c/p\u003e\n\u003cp\u003eThe required sample size for the patient group was calculated using the incidence rate formula proposed by Lwanga and Lemeshow, resulting in a minimum sample of 67 participants. Data collection was conducted over a continuous seven-day period, during which all eligible patients meeting the inclusion criteria were recruited through consecutive sampling method and a total of 89 unplanned readmission cases. For the nursing officer component, the sample size was determined using the finite population correction formula, which indicated a minimum requirement of 102 participants. A stratified random sampling technique was employed to ensure proportional representation of nursing officers from different wards and clinical units within the hospital.\u003c/p\u003e\n\u003cp\u003eData were collected using two structured, pre-tested questionnaires specifically developed for this study, by the investigators. An interviewer-administered questionnaire was used for patients and comprised 57 items designed to gather detailed information on socio-demographic characteristics, medical history, comorbid conditions, previous hospitalizations, discharge planning experiences, medication instructions, follow-up arrangements, and circumstances surrounding readmission. A self-administered questionnaire was used for nursing officers and included 61 items across ten domains addressing discharge planning practices, patient education, medication reconciliation, coordination of multidisciplinary care, communication methods, and strategies implemented to reduce preventable readmissions. The development of both questionnaires was guided by an extensive review of relevant literature and clinical guidelines and was made available in Sinhala, Tamil, and English to ensure participant comprehension.\u003c/p\u003e\n\u003cp\u003eEligible readmitted patients were identified on a daily basis using the hospital information management system and admission records. Interviews were conducted in the respective wards at times that were convenient for the patients and did not interfere with clinical care. Nursing officers were approached during duty hours, provided with information regarding the study objectives, and invited to participate. Questionnaires were distributed after obtaining written informed consent and were collected either on the same day or within an agreed period to minimize disruption to routine duties. To ensure the quality, reliability, and clarity of the data collection tools, a pre-test was conducted among ten patients and ten nursing officers in a comparable healthcare setting. Feedback obtained during the pre-testing phase was used to refine question wording, structure, and sequencing. Data collected at a p-value of less than 0.05.\u003c/p\u003e"},{"header":"Results of the 1st part","content":"\u003cp\u003eThe overall 30-day readmission incidence rate was 21.06% (946 patients). This includes 19.08% (857 patients) of planned readmissions and 1.98% (89 patients) unplanned readmissions. These rates correspond to approximately, 21 planned readmissions per 100 patients weekly or 210 per 1,000 patients weekly and 2 unplanned readmissions per 100 patients weekly or 20 per 1,000 patients weekly. Summary of readmission incidence rate was indicated in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Readmission Data (One-Week Study Period) (n = 4492)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eNumber of Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePercentage of Total (n = 4492)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTotal admissions assessed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4,492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAdmissions not within 30 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3,417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e76.07%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInitial 30-day admissions identified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1,075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e23.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"3\"\u003e \u003cp\u003eConfirmed readmissions\u003c/p\u003e \u003cp\u003e– Planned readmissions\u003c/p\u003e \u003cp\u003e– Unplanned readmissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e21.06%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1.98%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNon-readmissions (excluded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUntraceable patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003eApproximately 3428 planned readmissions per month and 44564 planned readmissions per year occur in National Hospital Galle. As well as, approximately 356 unplanned readmissions per month and 4628 planned readmissions per year occur in National Hospital Galle. Estimated projection for month and year indicated in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEstimated projections (Extrapolated from Weekly Data)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eReadmission Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eWeekly Incidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMonthly Estimate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAnnual Estimate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePlanned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3,428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e44,564\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnplanned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4,628\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003eThe present study involved a group of 89 patients. The gender distribution showed a higher proportion of males (55.1%) than females (44.9%). Age distribution skewed towards the elderly, with 38.2% of patients aged over 60 years and only 13.5% below 20 years. This aligns with literature indicating that older adults are more prone to readmissions due to co morbidities and functional limitations. A substantial majority of patients were married (76.4%) and Sinhala (93.3%), reflecting regional population patterns. The predominant religion was Buddhism (89.9%). Educational attainment was relatively low, with 15.7% never attending school and 38.2% having only primary-level education. Notably, 59.6% of participants were unemployed, and 39.3% had no source of income, suggesting that socioeconomic vulnerability may play a role in post-discharge challenges. To better understand the social demographic characteristics of these patients, their information was compiled and presented in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the re-admitted patients (n = 89)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003c/colgroup\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eColumn N %\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e44.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e55.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"6\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u0026lt; 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e20–30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e31–40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e11.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e41–50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e12.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e51–60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e18.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u0026gt; 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e38.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"5\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e76.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e21.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"5\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSinhala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e93.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTamil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBurgher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"5\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBuddhism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e89.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIslamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"7\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNot schooling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGrade 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e38.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eO/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eO/L Pass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e16.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eA/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e7.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eA/L Pass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e40.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e59.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"6\"\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e39.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u0026lt; 10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10000–20000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e20000–50000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e34.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e50000–100000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e10.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u0026gt; 100000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes patient-related factors associated with unplanned readmissions (n = 89). A majority of patients reported very good understanding of discharge instructions (67.4%) and health education (66.3%), and a similar proportion took medications without missing doses (67.4%). Follow-up-related challenges were reported by 52.8% of patients. Although most patients demonstrated concern about their health (84.3%), adequate home support (94.4%), and preparedness for home care (89.9%), adherence to nutrition education was relatively low, with only 22.5% fully following recommended dietary advice. Overall, the findings suggest that while general discharge understanding and support systems were strong, gaps in follow-up and nutritional adherence may have contributed to readmissions.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab4\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003ePatients Related Factors for readmissions\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePatient-Related Factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eNumber of patients (n = 89)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePercentages (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnderstood Discharge (Very Well)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e67.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFollow-up Issues (Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTook Medicines Without Missing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e67.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnderstood Health Education (Very Well)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFollowed Health Education (Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnderstood Nutrition Education (Very Well)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e44.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFollowed Nutrition (Fully)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePrepared for Home Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e89.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAdequate Home Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAble to Follow-Up (Always + Most)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e71 (30 + 41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e79.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eConcern About Health (Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e84.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e shows how hospital care and discharge processes were experienced by the 89 patients who were readmitted. Most patients felt that the basic steps were done properly before discharge. Almost all patients were given discharge instructions (91%) and information about their medications (92.1%). A large proportion were also told to attend follow-up clinics (85.4%) and received some form of health education (78.7%) and nutrition advice (74.2%). This indicates that routine discharge communication was generally provided.\u003c/p\u003e\u003cp\u003eDespite this, important gaps were identified in areas that directly support patients after going home. Only a small number of patients (18%) received a written care plan, which means many had to rely on memory or verbal instructions alone. In addition, less than half of the patients (43.8%) felt that their follow-up care was very satisfactory, suggesting problems with continuity of care after discharge. Teaching on how to manage medical devices was particularly poor, with only 9% receiving such instructions, placing these patients at higher risk of complications once they returned home.\u003c/p\u003e\u003cp\u003eMost patients (77.5%) stayed in hospital for only 1–3 days. While short hospital stays are often necessary, they may reduce the time available for detailed patient education and discharge planning. Although over half of the patients described their overall hospital experience as excellent (53.9%) and many felt well supported by the healthcare team (76.4%), these positive experiences did not always lead to smooth recovery after discharge.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab5\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHospital Related Factors for Readmissions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eHospital Related factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eNumber of patients (n = 89)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePercentages (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReceived Discharge Instructions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTold to Attend Follow-Up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e85.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInstructed About Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e92.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInstructed About Health Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e78.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInstructed About Nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e74.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInstructed to Manage Devices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHospital Stay 1–3 Days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOverall Hospital Experience (Excellent)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e53.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSupport from Healthcare Team (Very Supported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e76.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReceived Written Care Plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFollow-Up Care Very Satisfactory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e"},{"header":"Results of the 2nd Part","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e presents the socio-demographic characteristics of the nurses who participated in the study (n\u0026thinsp;=\u0026thinsp;102). The mean age of the respondents was 38 years, with an age range of 28 years and a standard deviation of 7, indicating a predominantly middle-aged nursing workforce. The sample was largely female, with 95 nurses (93.1%), while only 7 participants (6.9%) were male, reflecting the female predominance commonly observed in the nursing profession.\u003c/p\u003e \u003cp\u003eWith regard to ethnicity, the majority of respondents were Sinhalese (98.0%, n\u0026thinsp;=\u0026thinsp;100), whereas a small proportion belonged to Christianity (2.0%, n\u0026thinsp;=\u0026thinsp;2). In terms of professional experience, nurses had a mean of 12 years of service, with a wide range of experience spanning up to 34 years and a standard deviation of 7, suggesting a mix of moderately experienced and highly experienced nurses in the study setting.\u003c/p\u003e \u003cp\u003eConcerning professional position, most participants were Nursing Officers (79.4%, n\u0026thinsp;=\u0026thinsp;81). This was followed by Nursing Officer Grade I (15.7%, n\u0026thinsp;=\u0026thinsp;16). A smaller number of respondents held senior positions, including Nursing Officer Grade II (2.0%, n\u0026thinsp;=\u0026thinsp;2), Nursing Officer Grade III (2.0%, n\u0026thinsp;=\u0026thinsp;2), and Nursing Sister (1.0%, n\u0026thinsp;=\u0026thinsp;1). Overall, the table indicates that the study sample consisted mainly of experienced female nursing officers, providing a relevant perspective on hospital practices related to patient care and readmission prevention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the nursing officers (n\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColumn N %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSinhalese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eExperience years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing officer-Grade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing officer-Grade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing officer -Grade III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing Sister\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e presents the strategies currently used by nurses to prevent hospital readmissions. The findings show that nurses are actively involved in multiple preventive practices across readmission tracking, discharge planning, medication management, patient education, follow-up care, training, and patient engagement. Regarding readmission tracking, the most commonly used method was manual tracking, reported by 51 nurses (50.0%), followed by electronic health record (EHR) tracking used by 33 nurses (32.4%). In contrast, the use of standard protocols (10.8%), informal or personal methods (6.9%), and diagnosis cards or clinic books (1.0%) was relatively low, indicating limited reliance on structured or standardized tracking systems.\u003c/p\u003e \u003cp\u003eIn terms of discharge planning, patient education at discharge was the most frequently practiced strategy, reported by 71 nurses (69.6%). Planning for high-risk patients was also commonly implemented (52.9%), while discharge checklist use was reported by 38.2% of nurses. These findings highlight the emphasis placed on education-based discharge processes, though checklist-based approaches were less consistently applied. With respect to medication management, double-checking medications was the most widely used strategy (60.8%), followed by medication reconciliation (56.9%) and clarifying medication instructions (53.9%). This suggests a strong focus on medication safety practices aimed at reducing medication-related readmissions.\u003c/p\u003e \u003cp\u003eConcerning patient education, verbal education was provided by 59.8% of nurses, while nutrition and lifestyle education was reported by 51.0%. Written educational materials were less frequently used (45.1%), indicating a greater reliance on verbal communication rather than written resources. In the area of follow-up care, only 26.5% of nurses reported arranging post-discharge phone calls, and home visits after discharge were reported by just 8.8% of nurses. This demonstrates limited post-discharge follow-up practices, which may contribute to higher readmission risk.\u003c/p\u003e \u003cp\u003eRegarding training and support, lack of training was reported by a substantial proportion of nurses (60.8%), while only 38.2% indicated that they had received training related to readmission prevention, suggesting a notable gap in professional development. Finally, under patient engagement and communication, patient involvement in discharge planning was reported by 47.1% of nurses. Collaboration with family members (44.1%) and communication with caregivers (46.1%) were moderately practiced, indicating partial but inconsistent engagement of support systems in the discharge process.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Currently use strategies to prevent hospital readmissions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreventive Strategies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Nurses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentages (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eReadmission Tracking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManual tracking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEHR tracking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStandard protocols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformal/personal methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiagnosis card/clinic books\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDischarge Planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient education on discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlanning for high-risk patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDischarge checklist use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMedication Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDouble-check medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedication reconciliation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClarify medication instruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePatient Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWritten materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutrition/lifestyle education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-Up Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-discharge phone calls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome visits after discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTraining \u0026amp; Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReceived training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFelt lack of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePatient Engagement \u0026amp; Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient involvement in discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaboration with family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication with caregivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings revealed that the overall 30-day readmission rate was 21.06%, of which 19.08% were planned readmissions and only 1.98% were unplanned readmissions. This indicates that more than 90% of all readmissions were planned, highlighting a distinctive readmission pattern at NHG when compared with international healthcare settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Globally, reported 30-day readmission rates vary considerably. A large systematic review conducted in China reported an overall readmission rate of 7.6%, including 6.7% planned and 0.9% unplanned readmissions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In contrast, studies from Hong Kong and Australia have reported unplanned readmission rates of 16.7% and 7.4%, respectively [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While the total readmission rate at NHG (21.06%) is comparable to rates reported from other tertiary hospitals, the proportion of planned readmissions (19.08%) is markedly higher. This finding may be explained by the hospital\u0026rsquo;s role as a tertiary referral center, where patients frequently require repeated admissions for scheduled procedures, long-term therapies, and follow-up interventions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe unplanned readmission rate of 1.98% observed in this study is substantially lower than the 5\u0026ndash;20% range reported internationally [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, this low rate should be interpreted with caution. Oncology and dialysis units were excluded from the study, despite these units accounting for a significant proportion of unplanned readmissions in other settings. In addition, the short study period may have contributed to underestimation. Therefore, the low unplanned readmission rate may reflect methodological limitations rather than superior quality of care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatient-related factors were found to play an important role in readmissions. The elderly population accounted for a higher proportion of readmitted patients, particularly those aged 65 years and above, consistent with global evidence that aging populations are at increased risk of hospital readmission [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, patients with multiple chronic conditions such as diabetes, hypertension, and heart failure showed a significantly higher likelihood of readmission [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Shorter hospital stays were also associated with increased readmission risk, with patients discharged within five days more frequently returning to hospital, suggesting possible premature discharge or inadequate stabilization [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDischarge-related factors emerged as major contributors to readmissions. Although patients reported overall satisfaction with inpatient care, only 18% of patients received a written discharge care plan, indicating a substantial gap in structured discharge communication [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, 30% of patients did not adhere to dietary recommendations after discharge, highlighting deficiencies in patient understanding and follow-through [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These findings align with international literature identifying poor discharge education and inadequate communication as major drivers of preventable readmissions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe nursing officers\u0026rsquo; perspective further reinforced these findings. More than two-thirds of nurses reported dissatisfaction with current discharge processes, and only a minority confirmed routine post-discharge follow-up such as phone calls or home visits [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Medication reconciliation was reported as always performed by only 41.0% of nurses, while 34.4% indicated it was done only sometimes, increasing the risk of medication errors after discharge [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Additionally, only 29.5% of nurses reported regular involvement of a multidisciplinary team in discharge planning, and just 16.4% confirmed the use of electronic systems to track discharged patients or coordinate follow-up care [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e"},{"header":"Limitations of the study","content":"\u003cp\u003eThis research was carried out in only one therefore the results may not necessarily indicative of what is going on generally in other hospitals in Sri Lanka. Information collected through self-administered questionnaire may carry recall bias. Further, as information was gathered within a short time window, so it may not reflect seasonal or festival-related variation in readmission trends.\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eThis study analyzed readmission in the National Hospital Galle and explored the reasons behind it, both the hospital and patient factors. It also assessed what was being done to prevent readmission of patients. The results showed that while the unplanned readmission rate was 1.98%, a significant percentage-21%-were planned. These statistics, though not unusually high, emphasize that readmission is still an ongoing concern and one that needs more focus.\u003c/p\u003e \u003cp\u003eFrom the patient side, older age, multiple health conditions, and low satisfaction with care were more commonly seen in those who were readmitted. On the hospital side, gaps in discharge planning, follow-up care, and multidisciplinary teamwork were evident. Although most nurses reported giving discharge instructions (91.8%), only 36.1% said there was regular follow-up after discharge. Medication reconciliation and digital health systems were also not consistently used. Compared to what other nations practice, there is no doubt that some of the good strategies are being implemented while others-such as post-discovery calls at regular intervals, having the input of pharmacists, and through electronic records-are not being fully utilized.\u003c/p\u003e \u003cp\u003eIn conclusion, the study illustrates that improving the process of preparing the patient for discharge from and follow-up after hospital discharge could help reduce avoidable readmissions. The findings reveal sensible things that are possible to emphasize from the hospital to promote care and decongest patients and the health system.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ AMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Myocardial Infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ COPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ CVD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiovascular disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ HBSNFs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHospital-based Skilled Nursing Facilities\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ HRRP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHospital Readmission Reduction Program\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ LTDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLong-Term Chronic Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ NHG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Hospital Galle\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ NIMH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institute of Mental Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ PCPs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary Care Physician\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ SSHs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eShort-Stay Hospitalizations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ UK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e□ USA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited States of America\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate -\u003c/strong\u003eThe ethical approval for the proposed study was sought from the Ethics Review Committees of the Faculty of Allied Health Sciences, University of Ruhuna before the commencement of the study (Reference No – 2024.09.463), in accordance with the Declaration of Helsinki. Informed written consent was obtained from all participants before their enrolment in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e- Not applicable. Manuscript does not contain any individual person’s data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;-\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available from the corresponding author, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e: Payas A.L. M, Abeyrathne S.L.D. W, Thushari Bandara, Fernando G.H. S and Ranga Sabapathige confirm the sole responsibility for study conception and design, data collection, analysis, interpretation of results, and manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful to the Director of National Hospital Galle for granting permission and facilitating this study. Our appreciation also extends to the nursing officers and patients who willingly participated in this research\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProf. (Mrs.) W.V.R.T.D.G. Bandara, Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna Sri Lanka\u003c/p\u003e\n\u003cp\u003eAbdul Lathif Mohamad Payas, Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna.\u003c/p\u003e\n\u003cp\u003eSamarappulige Lakshani Dinithi Wimansa Abeyrathne, Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna\u003c/p\u003e\n\u003cp\u003eDr. Fernando GHS, Director, District General Hospital, Matale, Sri Lanka\u003c/p\u003e\n\u003cp\u003eDr. Ranga Sabapathige, Director, National Hospital Galle, Sri Lanka\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMinistry of Health, Nutrition and Indigenous Medicine. Guideline reporting readmission. Colombo: Government of Sri Lanka; 2013.\u003c/li\u003e\n \u003cli\u003eJencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418\u0026ndash;28.\u003c/li\u003e\n \u003cli\u003eGlans M, Borgstr\u0026ouml;m Bolmsj\u0026ouml; B, Jakobsson U. Risk factors for 30-day hospital readmission among older adults: a systematic review. Int J Older People Nurs. 2020;15:e12256.\u003c/li\u003e\n \u003cli\u003eYam CHK, Wong ELY, Cheung AWL, Chan FWK, Wong FYY, Yeoh EK, et al. Avoidable readmission in Hong Kong\u0026mdash;systematic review. BMC Health Serv Res [Internet]. 2010 [cited 2025 Oct 18];10:311. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-10-311\u003c/li\u003e\n \u003cli\u003eConsidine J, Berry D, Newnham H. Factors associated with unplanned hospital readmissions: an Australian retrospective cohort study. BMJ Open [Internet]. 2019 [cited 2025 Oct 18];9:e024941. Available from: https://bmjopen.bmj.com/content/9/4/e024941\u003c/li\u003e\n \u003cli\u003eColeman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822\u0026ndash;28.\u003c/li\u003e\n \u003cli\u003eAnderson GF, Steinberg EP. Hospital readmissions in the Medicare population. N Engl J Med. 1984;311:1349\u0026ndash;53.\u003c/li\u003e\n \u003cli\u003eBoutwell A, Hwu S. Effective interventions to reduce rehospitalizations: a survey of the published evidence. Cambridge: Institute for Healthcare Improvement; 2009.\u003c/li\u003e\n \u003cli\u003eJahnigen DW, Hannon C, Laxson L, LaForce FM. Hospital readmission in the elderly: relationships among demographic, social, and clinical predictors. J Am Geriatr Soc. 1982;30:433\u0026ndash;37.\u003c/li\u003e\n \u003cli\u003eNaylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613\u0026ndash;20.\u003c/li\u003e\n \u003cli\u003eAbesekara P, Perera A, Wijesinghe S. Predictors of readmission among patients with mental illnesses at the National Institute of Mental Health, Sri Lanka. Sri Lanka J Psychiatry. 2018;9:15\u0026ndash;21.\u003c/li\u003e\n \u003cli\u003ePergeline A, Le Fur S, Monnier A, Duguet A, Zureik M, Huas D. Short-stay hospitalizations and readmissions in children with long-term diseases. Arch Pediatr. 2023;30:144\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eJack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150:178\u0026ndash;87.\u003c/li\u003e\n \u003cli\u003eCarter J. Factors affecting patient readmissions within 30 days: a patient perspective. J Healthc Qual. 2019;41:222\u0026ndash;30.\u003c/li\u003e\n \u003cli\u003eBamforth L, Williams P, Jackson D. Preventing hospital readmissions: patient and nurse perspectives. J Clin Nurs. 2021;30:976\u0026ndash;85.\u003c/li\u003e\n \u003cli\u003eAdamuz J, V\u0026aacute;zquez-S\u0026aacute;nchez M\u0026Aacute;, Gonz\u0026aacute;lez-Ram\u0026iacute;rez M. Role of nurses in reducing readmissions: a systematic review. Int J Nurs Stud. 2021;123:104046.\u003c/li\u003e\n \u003cli\u003eHerzig SJ, Schnipper JL, Doctoroff L, Mathew C, Shieh MS, Burgess JD, et al. Hospital and primary care physicians\u0026apos; perspectives on hospital readmissions: a national survey. J Hosp Med. 2016;11:162\u0026ndash;67.\u003c/li\u003e\n \u003cli\u003eGupta A, Singh K, Patel S. Nursing interventions in reducing hospital readmission: a review. Nurs Outlook. 2024;72:43\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eForster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161\u0026ndash;67.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eH\u0026auml;yrinen K, Saranto K, Nyk\u0026auml;nen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform. 2008;77:291\u0026ndash;304.\u003c/li\u003e\n \u003cli\u003eVest JR, Gamm LD. Health information exchange: persistent challenges and new strategies. J Am Med Inform Assoc. 2010;17:288\u0026ndash;94.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Incidence rate, Hospital readmission, Causative factors, Preventive strategies ","lastPublishedDoi":"10.21203/rs.3.rs-9146946/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9146946/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eA readmission is defined as an unplanned subsequent hospital admission in the same or a different hospital within 30 days after discharge from hospital due to the same illness. Readmission rates and its causative factors could be used to measure the quality of health care and accountability. Present study was undertaken to determine the incidence and causative factors of hospital readmissions at National Hospital Galle, Sri Lanka and to study the ongoing strategies for their prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis is a descriptive cross-sectional study. A pre-tested interviewer-administered questionnaire was used to collect data from re-admitted patients for consecutive seven days. Further data were collected from nursing officers (n=102) who are participated in the patient discharge process at the same hospital to assess the strategies to prevent re-admissions. Data were analyzed using SPSS version 25.0, by using descriptive statistics, Pearson’s test and Chi-square tests wherever applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThis study assessed seven-day hospital readmissions among 4,492 patients admitted to the National Hospital Galle. A total of 946 patients were readmitted, during the study period giving an overall readmission rate of 21.06%. Most readmissions were planned (19.08%), while 1.98% were unplanned. Elderly patients (≥65 years) and those with multiple chronic conditions, including diabetes, hypertension, and heart failure, had higher readmission rates. Patients discharged within five days showed an increased risk of readmission. Readmitted patients reported lower satisfaction, particularly regarding communication and discharge instructions. Nursing staff surveys revealed dissatisfaction with discharge processes, inadequate patient education, limited post-discharge follow-up, and insufficient time and training for discharge counselling\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings concluded that, general readmission rate of NHG is 21.06% and unplanned readmission rate is 1.98%. The readmissions were significantly influenced by patients' dissatisfaction with post-discharge support and discharge communication, underscoring the need for improved patient education and follow-up.\u003c/p\u003e","manuscriptTitle":"Incidence Rates, Causes and Strategies to Prevent Hospital Readmissions at National Hospital Galle, Sri Lanka","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-01 07:42:10","doi":"10.21203/rs.3.rs-9146946/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-13T09:23:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T09:12:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T07:32:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97950034936711891404104033493593363960","date":"2026-04-05T23:03:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152572802063938091248933324137827083886","date":"2026-04-05T09:25:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308252705534985196405236305013537674092","date":"2026-04-03T21:23:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84732529148875110280487697527751065087","date":"2026-04-02T06:20:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279486419170287163321316108273991824388","date":"2026-04-01T08:31:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-30T05:25:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T05:23:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T21:30:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T11:34:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-27T11:29:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f3dca674-44c2-4e73-84e8-b355670dd1f3","owner":[],"postedDate":"April 1st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T05:09:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-01 07:42:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9146946","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9146946","identity":"rs-9146946","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}