Valley One of 14 Health Care Communities Leading National Effort to Reduce Avoidable Hospital Readmissions
FOR IMMEDIATE RELEASE
1-800-725-9216, Ext. 649
Austin, TX – May 10, 2010 — The United States has a 17.6 percent rate of hospital readmissions within 30 days, says Medicare. Especially at risk are patients discharged with a chronic illness such as heart failure or kidney disease or after a surgical procedure. (After surgery Medicare patients are often readmitted for conditions such as pneumonia, heart failure or bacterial infections.) Medicare patients report greater dissatisfaction related to discharges than to any other aspect of care that the Centers for Medicare & Medicaid Services (CMS) measures.
The Lower Rio Grande Valley is participating in a federally-funded national pilot program to reduce readmission rates for some seniors. The Valley is one of a handful of U.S. communities chosen for the Medicare-sponsored Care Transitions project. The project places the Valley, together with 13 other select communities nationwide, on the leading edge of a national effort to improve patient safety and reduce avoidable hospital readmissions.
“The Valley will teach us a lot. You will inspire and challenge the rest of us,” says Dr. Harlan Krumholz of Yale University and an internationally recognized heart disease specialist. Dr. Krumholz spoke to a packed room of nearly 100 Valley health care professionals at a conference in Brownsville last January targeting coordination of care, or when patients transition from one health care setting to another.
“Readmissions are an epidemic of immense proportions—off the radar screen,” said Dr. Krumholz. Reducing avoidable hospitalizations has become a Medicare priority. A study published in the New England Journal of Medicine last year stated unplanned rehospitalizations cost Medicare $17.4 billion in 2004. The good news is that up to 76 percent of Medicare readmissions that occur within 30 days may be avoidable.
So what should health care providers do to help prevent avoidable rehospitalizations? “Probably the three most important things health care professionals can do are making sure patients have a follow-up doctor’s appointment scheduled before they are discharged from the hospital, ensuring patients know what medications they should take after they leave the hospital, and providing written discharge instructions for the patients that are easy to read and understand. Patients should understand how their medication routine has changed from what it was before they were admitted,” says Jennifer Markley, RN, Director of the Lower Rio Grande Valley Care Transitions project to reduce avoidable hospital readmissions.
What hospital discharge professionals can do
Health care professionals in charge of quality or of discharging patients should make sure patients have a primary care physician and schedule a follow-up visit for them before they leave the hospital. This accomplishes two very important things:
- It helps keep the patient’s physician informed so that he or she can provide necessary follow-up care for a patient after the patient has been hospitalized. 2) It offers the opportunity for dialog between the hospital and the patient’s physician so that they both can better coordinate the patient’s care. In addition, health care providers should consider participating in the following projects and initiatives to help transition patients home or to another care setting safely:
- Project RED: Re-engineering Discharge—provides a checklist of components to be used by a Discharge Advocate. A clinical pharmacist or a nurse reinforces the components with a telephone call after discharge. http://www.bu.edu/fammed/projectred/index.html
- The Care Transitions Intervention—offers a full range of materials to support improved and more effective care transitions in your facility. The program and four pillars of care (medication self-management, dynamic patient-centered record, follow-up and red flags) are fully outlined. http://www.caretransitions.org
- Project BOOST: Better Outcomes for Older Adults through Safe Transitions—uses a team approach led by a hospital physician to assess patients’ risk for rehospitalization and plan and execute risk-specific discharge planning activities. http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/CT_Home.cfm
- H2H: Hospital to Home National Quality Initiative—cosponsored by the American College of Cardiology and the Institute for Healthcare Improvement, this initiative is an effort to improve the transition from inpatient to outpatient status for individuals hospitalized with cardiovascular disease. http://h2hquality.org
Links to all of the above programs can also be found on http://caretransitions.tmf.org, under “Provider Interventions & Tools: Hospitals & Inpatient Rehabs.” In addition, hospital discharge professionals should network with their peers in other care settings to improve patient handoffs.
“Providers need to work together. They need to get to know each other’s employees and processes. They need to standardize transfer forms,” says Dr. Joanne Lynn, a bureau chief in the Department of Health, Washington, D.C. “It takes a community to make a difference,” she says, “a commitment to the well-being of your community.”
Other steps you can take to decrease avoidable 30-day readmissions
To prevent patients from being readmitted when readmission is avoidable, health care professionals can take these additional steps:
- Prepare a discharge instruction sheet. Make sure patients can explain the instructions in their own words.
- Reconcile medications. “Patients should be educated on any new medications started during the hospitalization,” says Pam Stafford, Baylor Healthcare Process Improvement Consultant. “At Baylor, the process is standardized for heart failure patients systemwide using a Universal Medication Reconciliation Form. Some of our facilities also use an electronic medical record. Then, we take the time to educate patients about these things prior to discharge.”
- Evaluate for palliative care services. If the patient has been hospitalized multiple times and his or her condition doesn’t seem to be stabilizing or getting better, you may want to ask if the patient would be interested in information about palliative care services (care that focuses on making the best of each day during the last stages of illness).
“By scheduling follow-up visits, providing written discharge instructions and assuring patients understand their medications prior to discharge, you can greatly increase your patients’ chances of getting better after a hospital visit,” says Markley. “And that’s what hospitals, Medicare and patients all want.”
Few people would disagree with the argument that it’s stressful to have to return to the hospital following a serious illness or surgery. To help patients avoid the emotional and financial trauma of rehospitalization and help ensure a more positive long-term outcome, TMF Health Quality Institute recommends that hospitals play an active role in reducing avoidable rehospitalizations.
About TMF Health Quality Institute
TMF Health Quality Institute is a nonprofit consulting company focused on promoting quality health and health care through contracts with federal, state and local governments, as well as private organizations. TMF partners with health care providers in a variety of settings to ensure that every person receives the appropriate care, every time.