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Continued Care for Patients to Prevent Hospital Readmissions
By Marci Lawing, RN and Charu Raheja, PhD
The goal of any healthcare provider or facility is to offer safe, high-quality care for patients in all clinical settings. Preventing hospital readmissions is beneficial for both patients and healthcare facilities for multiple reasons. Not only are re-hospitalizations costly to providers and consumers, but also can sometimes lead to life-threatening complications due to gaps in the follow up care. Recent studies show that up to 75% of chronically ill patients that leave the hospital would not need a return trip if they had a plan for follow up care post hospitalization.
The Cost: Nationally, it is estimated that 20% of patients are readmitted within 30 days after discharge for the same diagnosis or one directly related to their initial admission (as cited in Cloohan, 2013). These readmissions are costing an estimated $17.5 billion to Medicare, $12 billion, of which, is potentially preventable readmissions. As a result, more recently, Medicare has announced cuts to 2,610 hospitals because they had readmissions within 30 days. Combined, the penalties cost the hospitals as much as $428 million.
Diagnoses with High Readmission rates:
While all readmissions are important, the diagnoses currently being focused on after discharge include: congestive heart failure (CHF), acute myocardial infarction (AMI), and pneumonia, which carry a 20-25% readmission rate. http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=1576244#sthash.btqjpkw0.dpuf
Who is At Risk for Readmissions?
Numerous studies have described the population at risk for readmission. Patients who are 75 years or older, male, African American, hospitalized with a medical diagnosis, and without insurance other than Medicare have been demonstrated to be at risk for readmission.
Patients with cardiovascular disease, chronic lung disease, renal failure, cancer, or diabetes have also been documented to be at high risk for readmission (Cloohan, 2013). http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=1576244#sthash.btqjpkw0.dpuf. Other factors are patients with lower health literacy. These patients have poorer knowledge of their chronic disease and therefore decreased ability to manage their conditions.
Often times, they are on multiple medications and dosages which change frequently and ad to the complication. Studies also show that senior citizens are more likely to misunderstand their discharge instructions and/or new medication regimens. Having a follow up Nurse Triage program that patients can call to ask questions can significantly help these patients get their questions answered once they go home.
Preventing Hospital Readmissions: Reducing hospital readmissions will involve the participation of the entire community. Hospitals that have been the most successful in reducing their readmission rates have used multi-disciplinary means and similar strategies.
Investing in quality care improvement, in other words, sticking to the quality standards already in place. The next tip sounds too basic, but it is simply caring for patients correctly. Don’t cut corners or rush through care. Always, follow hospital policy and procedures. Adhere to OSHA standard precautions and wash hands, frequently.
Use existing information technology (IT) tools in place, including: electronic medical records (EMR), patient registries and software that can identify those patients at highest risk for readmission.
Discharge teaching, telephone nurse triage and planning should start on admission. The most successful programs are the ones that make sure patients can effectively manage the conditions that put them in the hospital, the first time. It is also imperative that patients be familiar with the resources available for them once they go home.
Just as discharge teaching starts on admission to the hospital, it should not end upon discharge. Patients at high risk for readmission need follow up after discharge. This can be telephonically by registered nurses, case managers or patient navigators. It can also be by tele-monitoring, such as placing devices on patients so that vital signs and other risk factors can be managed more conveniently at home and physicians can intervene at an earlier stage.
A telephone nurse triage is also a great resource that should be available to patients to contact to ask questions and get reassurance. These nurses can evaluate the seriousness of the patient’s condition and help prevent unnecessary ER re-admissions.
Access to EMR by community-based providers can simplify care and reduce unnecessary costs accumulated by duplicating tests, medications or patient visits. Physicians can also communicate with each other via EMR to make sure their plan of care is both appropriate and tailored to each specific patient. Telephone triage nurses can also place notes from patient phone calls in the EMR, allowing physicians to review nurse notes during the day.
The strategies mentioned above, have proven effective for many hospitals. Preventing hospital readmissions saves patients time and money and also provides them with more resources to help better manage their chronic conditions.
“Hi, this is Dr. Raheja.”
“Decreasing hospital readmissions has been one of the key priorities of the healthcare system. Not only are readmissions costly for both hospitals and for consumers, but a patient that gets readmitted can also sometimes have life threatening complications. Having systems in place to prevent hospital readmissions is crucial for improving patient care.”
Did you know?
- Up to 20% of patients are readmitted within 30 days
- There is the potential to save $12 billion on readmissions
- Hospitals could lose as much as $428 million from Medicare cuts
“Make sure the patients have detailed discharge instructions as well as resources available to them, such as telephone nurse triage,that they can follow up on and call if they have any questions.”
“Please check out our blog below for more details and strategies on how to prevent hospital readmissions.”
Wall Street Journal, “Medicare to reduce hospital payments”
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