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January 31, 2017
How Hospitals Are Reducing Readmissions

Hospital readmission rates have dropped 8% between 2010 and 2015 — a big step toward more cost-effective, higher-value care. The big driver has been the Hospital Readmissions Reduction Program (HRRP), which targets avoidable hospital readmissions occurring within 30 days of initial patient discharge. With HRRP, the Centers for Medicare and Medicaid Services (CMS) is hoping to minimize the estimated $17 billion spent annually on readmissions that could be prevented.

Now it’s time to focus on further reductions in readmission rates. Here are some strategies hospitals are implementing to top up their HRRP success and enhance efficiency, patient care and cost reductions through preventing potential hospital readmissions.

Filling gaps in communication

A study from University of California San Francisco (UCSF) that focused on pinpointing the factors that contribute to the institution’s own hospital readmissions within 30 days of discharge found that 26.9% of readmissions were potentially preventable. What’s more, the key factor associated with readmissions was failures in communication. These failures came in the form of lack of follow-up with patients, failure to relay important information to outpatient healthcare and lack of discussions about care goals with patients. Implementing the use of medical scribes can help solve these many gaps with one solution. Scribes are not only trained in general documentation needs, but also in the particulars of a hospital’s electronic health record system and its ways of working. This means they ensure that documentation is complete — the first and most important step to providing information to post-acute care providers — while also generating any extra information that is needed. For example, scribes can document post-discharge care instructions and medication information that doctors communicate orally to patients, so that a written version can be given to patients, to reinforce care goals and information at home after discharge. Scribes can also provide messages and documentation between providers, to close communication gaps in the hospital.

Coordinating between acute and post-acute care

After successful treatment and discharge, the road to recovery is not necessarily complete. The key, then, is to carefully coordinate not only the transition from acute to post-acute care, but also the ongoing care that patients will require. Project BOOST (Better Outcomes for Older adults through Safe Transitions) is one tool for “optimizing patient discharge, improving communication between inpatient and outpatient providers and educating patients and families.” SSM St. Mary’s Medical Center in St. Louis implemented BOOST into their workflow in 2009, transformed its team-based care approach, and saw a decrease in readmissions from 12% to 7%. Their discharge strategy also included providing the patient with “a patient PASS”—a two-page document summarizing all hospital tests and diagnoses, important physician contact information, warning signs about the condition, scheduled follow-up appointments and necessary medications — giving patients and the primary care physicians all essential information in one place.

Another program, Smooth Transitions Equal Less Readmission (STELR), was established at the Lutheran Medical Center in Brooklyn to target congestive heart failure (CHF) patients. Along with education, follow-up appointments are scheduled with the patient’s cardiologist or primary care physician within 7 days after discharge, and case managers are arranged for home monitoring. The result: Readmission rates decreased from 32% to 24%.

Engaging and educating patients

Novant Health in Winston-Salem, NC, uses the Patient Education Materials Assessment Tool (PEMAT) to assess how understandable, actionable and effective patient education materials are for patients themselves. One strategy that meets those aims is the teach-back technique. It works like this: Caregivers check comprehension about the condition and potential action points by having patients repeat the information back to them. This not only helps reduce miscommunication, but also helps patients remember important points through repetition. And it works: PeaceHealth St. Joseph Medical Center in Bellevue, WA, has seen a 50% reduction in 30-day readmission rates using the teach-back technique.

Being sure to follow up

The Re-Engineered Discharge (RED) toolkit, originally developed by the Boston University Medical Center and funded by the Agency for Healthcare Research and Quality (AHRQ), facilitates effective coordination of discharge, patient education and post-acute patient follow-up. One of the many helpful tips is assisting patients in scheduling post-discharge appointments, along with coordinating follow-up phone calls. Nurses call patients 72 hours after discharge to inquire about pain, filling of prescriptions and any issues with attending follow-up appointments, as well as to answer any other questions patients might have. Results from Memorial Hospital in Marysville, Ohio have already shown a decline in readmission rates for CHF (readmission rates down from 15% to 9.1%), chronic obstructive pulmonary disease (from 20.6% to 11.8%) and pneumonia (from 10% to 9.7%) patients.

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