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Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, oncology, hospital admissions and readmissions, senior patients, and health policy.
Five initiatives, five success stories
Two years ago, Lori Dove, RN, vice president of post-acute care services at Lumberton, North Carolina-based Southeastern Health, went to her board of trustees seeking approval to hire 25 additional nurses. She believed the additional nurses would reduce the hospital’s 30-day readmissions rate, but she couldn't make any guarantees. Still, she got the go ahead from the board.
DoveDove staffed the hospital’s emergency department with what she calls “transition team nurses.” That’s because the emergency department is typically where acute myocardial infarction(AMI) patients represent-perhaps because they’re having a problem with weight gain, are not adhering to their medications, or have run out of oxygen.
Today, these transition team nurses go home with AMI patients upon discharge to do a medication reconciliation and home environment review. This can involve having the nurse confirm that patients who need to refrigerate their medications have running electricity to power their refrigerators. If they don’t, the nurse can work with the appropriate social service agency to get it turned on.
The approach has dramatically reduced AMI readmissions, in addition to saving more than $5 million, says Dove.
Healthcare innovators like Dove have leveraged follow-up strategies, pre-operative patient education, and more to reduce their readmissions rates. Here are four other ways hospitals are reducing readmissions.
Schedule follow-up care-stat
Pinehurst, North Carolina-based FirstHealth Moore Regional Hospital has improved its 30-day AMI readmissions rate by ensuring patients have follow-up appointments with their primary-care physicians within four days of discharge, says Dan Barnes, DO, president of the FirstHealth Physician Group and vice president of care transitions.
BarnesIt’s the cardiology team’s responsibility to make sure that a patient’s discharge summary is available within the EHR the same day as the discharge, he says. That translates into the availability of the patient’s electronic chart for the entire care team.
Connecting patients to their primary-care providers so quickly allows the entire care team to follow up on the patient’s care and check on their medications, both of which prevent readmissions and mortality, says Barnes.
“Physician champions were essential to our success,” says Cindy McDonald, RN, vice president of quality at FirstHealth. “This [type of initiative] can’t come from administration; it has to come from physician champions and clinical leadership.”
Deliver pre-surgery education
Sullivan Smith“When a patient has a hip or knee surgery, we’re not just replacing a joint,” says Mary Sullivan Smith, RN, senior vice president of hospital operations and chief nursing officer at Boston-based New England Baptist Hospital. “It’s a life-altering event. If a patient has a problem postop and it isn’t managed properly, then they’ll have reduced function and that interferes greatly with their life.”
To reduce its rate of readmissions after hip and knee surgeries, the hospital developed a preoperative class for the patient and their caregivers. Taught by nurses and physical therapists, the class covers the patient’s expectations about their recovery and their insurance coverage, in addition to possible barriers to care at home during the recovery process, says Eileen Galvin, RN, director of case management at New England Baptist Hospital.
“Having their family member or friend with them means that person can remind them after the surgery of what we covered during the class,” says Galvin.
Use the "teach back" method
Goldsboro, North Carolina-based Wayne Memorial Hospital has reduced its readmission rate due to serious complications after surgery with an educational method called “teach back,” says Donna Wimberly, RN, assistant vice president of patient care.
“That’s different from the way we used to do things. We used to talk to patients about the disease process and told them about their medications and asked if they had any questions,” says Wimberly. “Today, after we educate about the disease process, we ask the patient or a family member to tell us what they understand about the disease and their treatment. We also ask them to show us how to use the medical equipment we’re sending home with them.”
This approach helps patients and their families understand what they’re supposed to do once they get home. “That’s helpful if there’s a relapse or a complication,” says Wimberly.
Get patients on their feet
For Olympia, Washington-based Providence St. Peter Hospital, focusing on reducing blood clots was an easy choice. Blood clots are preventable events and they’re also one of the metrics for which the U.S. Department of Health & Human Services Agency for Healthcare Research and Quality has a patient-facing measure (one that has a direct impact on patient outcomes), says Jill Cooper, RN, vice president of quality for the Southwest Washington Region of Providence Health and Services.
CooperCooper notes that for a long time, providers thought it was either too painful or too risky to have patients walking around the day of surgery or the next day. “We know now that none of those things are true. Even if patients are sitting at the edge of their bed the day of their surgery, that’s a movement in the right direction,” she says.
The clinical team also uses sequential compression devices (SCD) to keep a patient’s blood moving. “We do this for the same reason they tell you to walk around when you’re flying on an airplane,” she says. “You need to move your legs around. Stagnant blood is a risk factor for blood clots. With SCDs, we can mimic that movement in a patient’s lower leg.”
Aine Cryts is a writer in Boston, Massachusetts.