Mission Health, a large healthcare system in Asheville, North Carolina, decreased readmissions by more than 14% after introducing Good to Go by Vocera, which makes audio and video discharge instructions available to patients via mobile app.
Piloted in a 33-bed general surgery unit in 2014, nurses used Good to Go to record instructions for 27% of patients in 2015, says Ellen Ferguson, a registered nurse and Mission Health discharge process team member. "During that period, 11% of those patients accessed their instructions."
The decision to utilize the app was driven in part by a Mission Health review of best practices to address readmissions for high-risk patients with chronic obstructive pulmonary disease and heart failure, says Linda Anderson, director of nursing. One of the best practices identified was a finding from the Agency for Healthcare Research and Quality that recorded discharge instructions can help reduce readmissions.
Key features of Good to Go that made it appealing to Mission Health include ease of use for nurses and patients, and the ability to access instructions and attach educational materials, such as videos, says Anderson. "Hospital readmission increases a patient's risk of complication and negatively impacts satisfaction," she says, adding that readmissions also harm hospital finances.
Higher penalties for readmissions
Indeed, the imperative to reduce preventable readmissions increased in 2012 with implementation of the Affordable Care Act's Hospital Readmissions Reduction Program. It requires the Centers for Medicare and Medicaid Services to reduce payments to Inpatient Prospective Payment Systems with excess readmissions. Currently, Medicare spends more than $17 billion annually on avoidable readmissions and imposes penalties on up to 3% of inpatient claims for 30-day readmissions.
"Patients who are readmitted to the hospital within 30 days of their discharge are subject to no reimbursement from Medicare. This can become a very expensive loss for hospitals," says David Collins, senior director of health information systems, Healthcare Information and Management Systems Society (HIMSS), Chicago. "Leveraging mobile health technology serves several purposes. It provides a way to engage patients in their own care. Being discharged with a tablet and other technology allows patients to connect with their provider who can tell if the patient is complying with their new medication regimes."
Zachary Clement, Mission Health's nursing quality and safety manager, says technology can help reduce hospital readmissions through enhanced communication between patients, family and the care team. "Technology can help us communicate better with patients and families by giving them a tool that fits their needs at any desired time," he says.