How Can Doctors Reduce Patient Readmission into the Hospital?

Hospital readmissions are associated with increased financial costs and poor patient outcomes. 20% of Medicare patients are readmitted to a hospital within 30 days of being discharged, out of which 12% are potentially avoidable. Preventing this 12% of readmissions could save Medicare over $1 billion dollars. Furthermore, the federal government projected that out of an annual cost of $26 billion dollars in Medicare readmissions, over $17 billion dollars are considered avoidable. For this reason, reducing hospital readmission rates have become a priority on a national level.

In 2012, CMS launched the Hospital Readmissions Reduction Program (HRRP). This program penalizes hospitals that fail to meet readmission benchmarks for three medical conditions: heart failure, acute myocardial infarction, and pneumonia. One year following the launch of the hospital readmissions reduction program, CMS estimated that the total cost in penalties reached over $290 million dollars. In 2015, the total cost in penalties reached up to $428 million! So how can healthcare professionals identify patients at a higher risk of hospital readmission? Based on several research studies and hospital initiatives, here are 13 proven ways to reduce patient readmissions:

1. Enhancing patient engagement and education
Patient education is an important aspect when it comes to driving high patient engagement. By educating patients in health-related matters, they can learn how to better care for themselves and to become more aware of their surroundings. For instance, by teaching patients on what to expect before and after a surgical procedure (diet plan, exercise tips, the procedure itself, treatment program, possible side effects, and more), readmissions can be reduced and outcomes can be improved.

2. Identifying the patient populations that are at highest risk of readmissions
Research findings suggest that Medicaid patients and patients without insurance are at an increased risk of hospital readmissions that are preventable. More specifically, evidence shows that readmission rates are 50% higher for uninsured patients in comparison to privately insured patients. States with the highest readmission rates include: Washington D.C., Maryland, Louisiana, West Virginia, New Jersey, New York, Mississippi, Massachusetts, and Illinois. Therefore, targeting specific patient populations is key to reducing or preventing readmissions altogether.

3. Targeting patients with limited understanding of the English language
Countless healthcare professionals have stated that patients with limited English proficiency (LEP) are at an increased risk of hospital readmission. For this reason, the Joint Commission established new requirements for hospitals in delivering care to patients with limited understanding of the English language. Such requirements include interpreters who have undergone training and present fluency competence in spoken languages and American sign language for deaf and hard-of-hearing patients.

4. Ensuring patients schedule a follow-up appointment within 7 days after being discharged
Several studies have shown that patients who scheduled a follow-up appointment within 7 days after being discharged were less likely to be readmitted to the hospital. By working together with patients and ensuring that they schedule a follow-up appointment, they can learn to follow preventative measures, stay engaged in their own care, and better care for themselves.

5. Using whiteboards
Believe it or not, the use of whiteboards has been shown to significantly improve communication of treatment plans across hospital teams. Staff members can use whiteboards to keep track of patients’ medications, health statuses, and daily goals. Furthermore, whiteboards can be used to educate patients by helping them understand their follow-up appointment information, discharge dates, post-discharge instructions, and more. The more patients understand their care plans, the less likely they will be readmitted to the hospital.

6. Preventing infections at surgical sites
According to a study published in the Journal of the American Medical Association, surgical site infections are the most common reason for unintended hospital readmissions. Having staff members that are certified in wound care, able to address appropriate topics such as hygiene, and follow cleansing surgical site protocols, are all important factors in increasing awareness and preventing infections at surgical sites

7. Training hospital care teams
Training hospital care teams to work together as navigators for patients can result in improved teamwork, patient care and best of all, at no cost. What’s more, hospital care teams that are ‘on the same page’ and implement the ‘teach-back’ method lead to increased patient engagement and patient education. This, in turn, can result in reduced admissions following the 30-day discharge, as well as improved patient outcomes.

8. Using nurses during patient care
Countless studies have shown that using nurses efficiently during patient care can result in fewer admissions. In fact, according to a study conducted back in 2008 that took into account 1,900 patients at 4 hospitals during the course of 7 months, researchers found increased nurse care resulted in lower rates of readmissions. By improving nurse training in terms of discharge teaching, this will result in increased patient engagement and decreased preventable readmissions.

9. Establishing a home healthcare program
Research has shown that home healthcare programs can be quite effective in preventing readmissions. Home health services include wound care, help with injections, patient education, tracking health status, monitoring medical condition(s), and providing nutritional or intravenous therapy. According to a study conducted by Avalere Health, home healthcare for severely ill patients resulted in more than 20,000 fewer readmissions in comparison to severely ill patients receiving prolonged care at the hospital. Home healthcare programs can help patients regain their independence, improve their health status, and become self-sufficient to the best of their abilities.

10. Ensuring smooth transitional care
Transitions include admissions and discharges in long-term care facilities, acute-care hospitals, assisted-living facilities, nursing facilities, and home. Having a transitional care team to help assist in monitoring and caring for patients after they have been discharged has shown to decrease hospital readmission rates. A few studies have shown that hospitals who invest in transitional care coaching can reduce their 30-day readmission rates anywhere from 10-50%. Moreover, nurses have been shown to play significant roles in transitional care by means of increasing patient education and providing high quality care.

11. Improving discharge planning and communicating post-discharge instructions
Patient communication, education, and engagement are all essential elements when it comes to prevention of hospital readmission. Monitoring patients and educating them on their health, medical conditions, procedures, and treatment methods is necessary to ensure understanding and compliance. The ‘teach back’ method, which involving having the patient repeat back the information that they have been presented with, has proven to be an effective approach in complete comprehension. In fact, the UCSF Medical Center implemented this approach and reduced both 30-day and 90-day readmissions for heart failure in patients aged 65 and older by a total of 30%.

12. Extending retail pharmacy hours
According to a study published in the Journal of the American Pharmacists Association, there is a connection between retail pharmacy hours and readmission rates. Researchers have found that readmission rates drop as outpatient pharmacy hours are extended. Therefore, by increasing patients’ access to pharmacy services, patient care is increased and hospital readmission rates are, in fact, reduced.

13. Implementing Telehealth
Telehealth has shown to be an interesting approach to communicating both visually and verbally with patients, especially those patient groups at high risk of readmission. Nowadays, wireless technology can be used to educate, monitor, and manage patients’ health from a remote location. This can result in peace of mind and helpful coping mechanisms when striving to reach the goals of treatment.

Doctors and hospitals that pursue all of these 13 strategies may be able to achieve better patient outcomes and fewer penalties. The most important aspect when it comes to delivering quality care is to listen to the patient and create a care plan that reflects their needs, wishes, and values. With such a plan, patient readmissions can be avoided or prevented altogether. By providing patients and family members with informed options, opportunities for interventions, as well as proper counseling, enhanced progress can be made towards better patient health and fewer admissions.