OBJECTIVES: The Royal London Hospital is a teaching hospital in East London, United Kingdom. We hypothesised that medical patients with multiple co-morbidities and complex disease are likely to present with a new diagnosis when re-admitted within a month. Further, re-admission within a week is likely to be related to the initial diagnosis. METHODS: We conducted a retrospective audit of all non-elective adult acute medical admissions over a 6 week period during 2012. We collected information on patient demographics, ICD-10 diagnosis, length of hospital stay, along with readmissions within one week and one month. We reviewed the original and subsequent electronic discharge summaries. We highlight patient specific and disease specific factors. RESULTS: There were a total of 124 readmissions from the original audit (n=859). A large proportion (40%) of all readmissions were in the elderly (over the age of 70). There were 73 (59%) readmissions within 1 month, and 37 (30%) within a week. Fourteen patients (11%) were readmitted within a week, and again within a month. COPD (33%), PE (29%), sepsis (26%) and cellulitis (24%) had the highest re-admission rates. Our audit points to a 14.4% readmission rate in our cohort. We aim to address the precipitating factors in our new physician led ambulatory care clinic. We highlight the bed days saved through such a clinic. CONCLUSIONS: Contrary to our hypothesis readmissions within a month were related to the original diagnosis, interestingly this was less so when re-admitted within a week. Our audit has helped highlight the need for better community management plans prior to discharge. This has led to closer links with the  Community Rehabilitation and Support Team (CReST) in order to reduce readmission rates.