When you see the term hospital readmission, it is quite eponymous. This doesn’t mean that the concept of its implementation is a simple linear process. It can get quite complicated.In defining the term, we can say that hospital readmission is the situation where a patient is readmitted to a hospital after he/she has been discharged for the same reason or for a related medical issue- not for a related medical issue. Sometimes patients get cured of their initial illness but pick up a new one in the hospital and this causes them to get readmitted. Scary I know. Hospitals constantly seek to reduce their rate of readmissions for more reason than one. This is true but the crux of the matter is that readmissions can be expensive – both for patients and for the hospital. For one, Medicare penalizes hospitals when they don’t meet readmission benchmarks. This has caused hospitals to constantly implement different Readmission Reduction Programs. Although hospitals reduced avoidable readmissions for Medicare patients by about 100,000 in 2015, and by a total of 565,000 since 2010, there’s still much room for improvement. The federal government has estimated the annual cost of Medicare readmissions to be $26 billion per year with $17 billion of that considered avoidable. Below we discuss two Readmission Reduction Programs that hospitals have implemented in the past to help
Reducing Heart Failure
Readmissions with an
EDW and Analytics
Heart failure is one of the highest causes of hospital readmission hence the specific focus on it. From improved reports to driving improvements, the benefits of an EDW and analytics applications are many. In fact, one large health system reduced heart failure readmissions by using an EDW as a foundation for its advanced analytics applications.
Some outlined specific interventions based on best practices that would move hospitals toward their goal of reducing readmissions were:
Within 48 hours of discharge, a physician reviews a list of the patient’s medications with explicit instructions to the patient about how to properly take them.
Before being discharged, nurses schedule patients for follow-up care. When possible, patients at high risk for readmission are scheduled to be seen within seven days of discharge.
Post-discharge phone calls
Within a specified timeframe following discharge, a member of the care team calls patients to assess their condition and answer any questions. An integrated dashboard was created in the healthcare EDW platform for each of the three interventions. This enabled clinicians and administrators to track where the interventions were being applied. They could also track the impact the changes were having on readmissions. Even more, the EDW and analytics applications allowed the team to assess the impact of the interventions on costs and patient satisfaction.
This is a smart approach, as a 2015 study published in the Journal of the American Medical Association found that surgical site infections are the most common reason for hospital readmissions. A good example of this is the case of New England Baptist Hospital. New England Baptist started with the hospital’s wound care committee, which includes eight nurses who were certified in wound care as well as one surgeon. The team researched the best dressing supplies and studied how often wound dressings were being changed and by whom.The team discovered a great deal of variability in how patients’ wounds were being dressed, related to the use of proper hand hygiene, the appropriate use of tape, and the different providers who were actually dressing patients’ wounds. The team found that dressings were being changed by a physician assistant or a nurse, which meant that many people were picking up a dressing and looking at a wound, which increased the chances of variability. The hospital’s current protocol then involved dressings that were only changed once before the patient was discharged, and some weren’t changed at all. If the dressing is changed, it must be changed by a nurse who follows the appropriate protocols. Patients can then remove the dressing at the appropriate time once they get home.
As a result, fewer staff members are touching patients’ wounds and wounds had less exposure to the environment, which meant fewer infections. The wound care team also educated the entire clinical team about wound care protocols twice a year to increase awareness.