HOSPITAL Score — Avoidable Hospital Readmission Risk
The HOSPITAL score predicts the risk of 30-day potentially avoidable hospital readmissions using 8 clinical variables. It was designed to identify patients at high risk for readmissions that might be prevented better transitional care.
About
The HOSPITAL score was developed by Dr. John Donzé and colleagues at Brigham and Women's Hospital / Harvard Medical School, published in BMJ in 2013. It was derived from a cohort of 9,210 medical patients discharged from a tertiary care academic medical center. The acronym HOSPITAL represents 8 predictors: Hemoglobin <12 g/dL at discharge, Oncology service discharge, Sodium <135 mEq/L at discharge, Procedure during hospitalization (any therapeutic or diagnostic procedure), Index admission type (urgent/emergent admission), number of Admissions in the past 12 months (0-4+ categorized as 0-5 points), length of stay ≥5 days, and admission from a Nursing home. Total score ranges from 0 to 12. The score has been externally validated in multiple international cohorts with c-statistics of 0.71-0.78. The main advantage of HOSPITAL over LACE is its focus on potentially avoidable readmissions rather than all-cause readmissions, and its incorporation of modifiable risk factors (e.g., anemia, hyponatremia) that can be addressed during hospitalization.
Formula
H(hemoglobin <12) + O(oncology) + S(sodium <135) + P(procedure) + I(urgent admission) + T(admissions past 12 months) + A(nursing home) + L(LOS ≥5)
H (Hemoglobin <12 g/dL): 1 point. O (Oncology service discharge): 1 point. S (Sodium <135 mEq/L): 1 point. P (Procedure during hospitalization): 1 point. I (Index admission type: urgent/emergent): 1 point. T (# admissions in past 12 months): 0=0, 1=1, 2=2, 3=3, ≥4=5 points. A (Admission from nursing home): 1 point. L (Length of stay ≥5 days): 1 point. Total: 0-12.
Score Interpretation
The HOSPITAL score specifically targets avoidable readmissions — those that might be prevented with better transitional care, medication reconciliation, and outpatient follow-up. Unlike all-cause readmission tools, HOSPITAL focuses on modifying clinical factors during the hospitalization. Studies have shown that HOSPITAL-identified high-risk patients benefit from intensive transitional care interventions, with some centers reporting 20-30% relative reductions in 30-day avoidable readmissions after implementing HOSPITAL-guided discharge planning. The score is particularly useful in academic medical centers and large community hospitals with diverse medical patient populations.
Low Risk — 0–4
30-day avoidable readmission risk <10%.
Management: Standard discharge planning.
Intermediate Risk — 5–6
30-day avoidable readmission risk 10-15%.
Management: Enhanced discharge planning with 7-14 day follow-up. Medication reconciliation prior to discharge.
High Risk — 7–12
30-day avoidable readmission risk >15%.
Management: Intensive transitional care management program. Early follow-up within 7 days. Home health referral and telehealth monitoring.
Reference Ranges
| Population | Normal Range |
|---|---|
| General medical inpatients | 0 (low risk) to 12 (high risk) |
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View medical review board & editorial policy →Example Calculation
A 68-year-old woman with metastatic breast cancer (oncology service), Hb 10.2 g/dL, Na 132 mEq/L, admitted urgently for dyspnea, had a thoracentesis during stay (procedure), 2 admissions in past year, LOS 6 days, lives at home. H=1, O=1, S=1, P=1, I=1, T=2, A=0, L=1. Total HOSPITAL=8/12 (high risk, >15% avoidable readmission).
Related Conditions
Common Mistakes
Using admission hemoglobin instead of discharge hemoglobin
The HOSPITAL score uses the lowest hemoglobin in the 24 hours before discharge, not the admission value.
Under-counting prior admissions
Include all unplanned hospital admissions in the 12 months prior to the index admission, including transfers from other facilities.
Frequently Asked Questions
How is HOSPITAL different from LACE?
Does the procedure variable include imaging?
References
- Donzé J, Aujesky D, Williams D, et al. Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. BMJ. 2013;347:f5552. PubMed
- Donzé J, Lipsitz S, Bates DW, et al. Validation of the HOSPITAL score for identifying patients at high risk for potentially avoidable readmissions. J Hosp Med. 2014;9(11):710-715.