This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Not every readmission is a failure of care: some patients come back because their disease progresses as expected. The HOSPITAL score, published by Donzé and colleagues in 2013 from more than 10,000 discharges in Boston, predicts potentially avoidable readmissions within 30 days. Its seven items are all available on the day of discharge, and the name is a mnemonic.
The items
| Letter | Item | Points |
|---|---|---|
| H | Hemoglobin under 12 g/dL at discharge | 1 |
| O | Discharge from an Oncology service | 2 |
| S | Sodium under 135 mmol/L at discharge | 1 |
| P | Procedure during the stay (any coded procedure) | 1 |
| I, T | Index admission Type: urgent or emergent | 1 |
| A | Admissions in the previous 12 months: 0 to 1 = 0, 2 to 5 = 2, more than 5 = 5 | up to 5 |
| L | Length of stay of 5 days or more | 2 |
The total runs from 0 to 13.
Example
A patient with a hemoglobin of 11 g/dL (1), an emergency admission (1), an endoscopy during the stay (1) and three admissions in the past year (2) scores 5: intermediate risk, with a potentially avoidable readmission in about 12% of similar patients.
Risk categories
| Score | Risk | Potentially avoidable readmission within 30 days |
|---|---|---|
| 0 to 4 | low | 5.8% |
| 5 to 6 | intermediate | 12.0% |
| 7 or more | high | 22.8% |
Validation
The score was validated in an international study of nine hospitals in four countries, where it kept good discrimination, and it performs at least as well as LACE in most comparisons. A simplified version replaces the procedure item and counts the length of stay differently.
How it is used
Patients at high risk benefit most from transitional care: medication reconciliation, clear written instructions, a follow-up visit within 7 days and a phone call after discharge. Applying these resources to every patient is costly; the score helps focus them.
Limits
The score was built in academic medical centers in the United States. It does not include social factors, which strongly influence readmissions, and it should support, not replace, the discharge team’s judgment.