Hospital Readmission: A Case Study

The descriptive statistics were used to evaluate the occurrence of rehospitalization within 30 days (readmission return to emergency department) and discharge outcomes (length of the stay and discharge time). Table 2 on page 252 presents the number and percentage of patients readmitted within 30 days from both groups; this descriptive statistic is also presented in the Figure on page 252. The mean length of stay and standard deviation are included in the same table. In addition, the inferential statistics, such as the t test, the Chi square (2), and logistic regression (odds ratio) were used. The t test was used to analyze interval or ratio data, for example: the length of stay or time of discharge. The Chi square (2) test was used to analyze nominal/categorical data, for example: to assess the relationship between the readmission to the hospital (or ER) and the type of medical team the patient had (with or without the NP). The authors considered a p value below 0.05 as a significant. In addition, the odds ratio was calculated using the logistic regression to

It may seem inevitable that high readmission rate is one of the challenges that an acute care setting is currently facing. According to studies, 20 percent of Medicare patients alone, get readmitted within 30 days of discharge. (Alper, E., O’Malley, T., & Grrenwald, J. 2017). Avoiding or preventing hospital readmission within 30 days of discharge can help Medicare save around $17 billion dollars yearly. (Morse, S. 2016). Understanding and getting to the root of why high re-admission rates still occur is highly important. Not only it will be cost effective but will also create a better well-being on the patients.

Policy makers created the Medicare Hospital Readmissions Reduction Program (HRRP) in an attempt to improve quality of patient care and lower costs (James, 2013). In order to avoid these penalties, healthcare leaders must recognize that CMS has identified a correlation between readmissions and a lack of quality care. Therefore, the aim is not to focus solely on hospital readmissions, but to seek clinical excellence by investing in quality improvement (Silow-Carrol, Edwards & Lashbrook, 2011). However, reducing readmissions is a complex undertaking, because not all readmissions can or should be prevented. Indeed, some readmissions are planned as part of sound clinical care. Furthermore, while hospitals work to reduce readmissions caused

Our project is directly applicable to objectives being covered in the MAN 334 course. By examining and analyzing hospital readmissions and understanding the various factors inherent to the discharge process, our team is defining significant characteristics related to the quality of services provided to patients in an inpatient setting. In class we learned that the readmission rates serve as a quality benchmark for health

2. Review of the current state of knowledge Transition in care and hospital readmission Definition of transition in care is “a set of actions designed to ensure for the coordination and continuity of health care as patients transfer between different locations or different levels of care” (Coleman, Boult, & American Geriatrics Society Health Care Systems Committee, 2003) A review of the current state of knowledge in the area showed that the reasons for acute-hospital readmission from skilled nursing care facility are very complex and various interventions have been tested to prevent readmissions. In addition to the risk factors in patients, such as multiple complex , complicated, and chronic medical conditions, fragmentation of health care , access to the care, and lack of

The number of readmissions into a hospital before 30 days and costs associated continue to increase significantly. According to the Centers for Medicare and Medicaid Service (CMS) penalties for preventable readmissions could approximately equal 528 million. This is an increase of about 108 million from the year before. These numbers are perplexing and shocking. Although, there may be many variables on why these numbers are so high I think focusing on patient education upon discharge to decrease readmission rates, especially in chronic illness is important.

While there are many studies done on this aspect of patient care and guidelines have been developed to assist in the reduction of the rate of unplanned readmissions, there is still much to be done to reduce the occurrence, especially in bridging the gap between hospitals, the community, family and ultimately the patient. Support for this approach has been generated by The American Hospital Association (AHA) Committee on Research led by Chu, B., K., Brien, J., G (2012) in its framework for health reform,

The hospital readmission (HR) may be regarded as an indicator of the quality of hospital care and, indirectly, of primary care. Some factors may foster HR, such as low quality of supportive care, early discharge, lack of treatment adherence on the part of users and their families, age, absence of specific guidance and post-discharge follow-up, as well as socioeconomic and cultural conditions. Therefore, in order to perform a resolute care, one needs to know the profile of admissions and of HR, thereby enhancing the planning and the implementation of strategies. In order to raise the aforementioned questions, this study had the purpose of analyzing the profile of readmissions of children treated in the pediatric sector of the Regional Hospital in Ceilândia (HRC) in March, April and May 2015. This

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

A hospital readmission is defined as one that occurs when a patient is admitted to a hospital within a specified time period after being discharged from an earlier (initial) hospitalization. For Medicare, this time period is defined as 30 days. Some of the quality care issues arise within the hospital among staff and also at home after patient discharge. Some of the highest rates of readmission within the 30 days are related to some of the following factors: complications from treatments during a hospital stay, inadequate treatment/inadequate care, coordination and follow up care at home and unexpected worsening of the disease after discharge from the hospital. Patients often face challenges with medication compliance and administration, not understanding the nature of their disease, and also where to get their questions answered once at home. The health care system has come to the conclusion that most of these issues is the leading factor in patient readmission. The most cost efficient solution to the problem of avoidable readmissions is patient education and after discharge follow up. Providing discharge instruction pamphlets to patients is not adequate enough information to yield results. Often times it is left with the patient’s belongings in a bag and never read. This gap in quality care is costing hospitals

Risk Factors: Before changes can be made to reduce readmission, an evaluation needs to be made to what is contributing to readmissions. In 2012, an average monthly readmission was 44 patients for every 1,000 FFS beneficiaries discharged (Gerhardt et al., 2013). Besides disease process, one of the risk factors, mentioned in the articles were lower cognitive functioning. Depression, which is common later in life, can effect cognitive functioning. To measure depression, the use of the Geriatric Depression Scale (GDS) has been tested to be a reliable tool (Greenberg, 2007). Poor clinical status, older age and poor health behaviors are also factors (Tao & Ellenbecker, 2013). Lower functional ability has be shown to contribute to increase risk for readmission. Functional ability can be measured by the scoring criteria in the Lawton Instrumental Activates of Daily Living Scale and the Katz Index of Independence in Activities of Daily Living (Graf, 2008a; Tao & Ellenbecker, 2013; Wallace & Shelkey, 2007). Communication breakdown and the lack of continuity between the hospital setting and the home setting also contributes to poorer patient outcome (Berry et al., 2011).

A simple tool known as LACE index can calculate the readmission risk by using length of stay, acuity of patient admission, Charlson co-morbidity index (21) and the number of emergency visits in the last 6 months (3). However, it does not take into account the patient’s functionality and mobility, which has been shown to be associated with readmissions (1,22,23). LACE index were shown to be poor at detecting emergency readmission in a study from the United Kingdom (24). Polypharmacy and exposure to certain medications such as anticonvulsants, benzodiazepines, opioids and antidepressants, (25) were also identified as risk factors. Other researchers pointed out certain diseases such as malignancy (15,26), heart failure (15,27,28), advanced chronic obstructive pulmonary disease (COPD) (29,30), depression (31–34) and anxiety (33) as risk factors.

Hospital readmission was first seen in literature in 1953 by Moya Woodside analyzing outcomes in psychiatric patients in London. Health systems watched hospital readmissions as a response in rising healthcare costs and saw specific groups of patients who were high users of healthcare. The Patients had chronic illnesses and were often readmitted to manage them. Throughout

The nursing clinical judgment of the process for the patient to prevent early readmission is shown below. ( “ ”: category)

In 2010 the ACA was passed, it established a Hospital Readmission Reduction Program. What this program did was to penalize hospitals if a patient gets readmitted for the same condition within 30 days of being discharged. Readmissions are significant because they account for approximately one-third of the nation’s health costs. When hospitals use a patient-centered discharge process, the patients are then able to reconcile their medications, follow-up with community-based providers, and self-manage their diseases and treatments. The patient-centered discharge process helps to reduce hospital readmissions. (Cloonan, Wood, & Riley, 2013) By properly educating the patient before discharge it reduces the risk of the patient getting readmitted. Discharging a patient without proper education can result in the patient improperly discontinuing their medication or failing to follow-up with their primary care provider.