Return To The ER: A Case Study

In 2011, there were approximately 3.3 million readmissions to hospitals, raising healthcare costs and negatively impacting patient health. Two important contributors are discharge planning and education. Many patients do not receive enough of either, and are sent home misinformed about their diagnosis and medications. In order to decrease readmissions, hospitals should utilize interactive patient systems to educate patients while they are in the hospital. This will increase patient knowledge of their diagnosis, as well as make it easier for nurses to go over discharge teachings with the patient. This gives

What factors contribute to multiple Chronic Obstructive admissions and how can the number of readmissions within 30 days be reduced? The Affordable Care Act added section 1886 to the Social Security Act. This section created the Hospital Readmission Reduction Program (HRRP). The purpose of HRRP is to reduce hospital spending and improve quality of care (Sjoding & Colin, 2014). HRRP requires Centers for Medicare and Medicaid Services (CMS) to reduce, or penalize, hospitals receiving payments from CMS for excessive admission of several chronic diseases, taking affect in October 2012 (CMS, 2018). Chronic Obstructive Pulmonary Disease was added in 2015 as one of these conditions.

Based upon the information provided, it has been determined that: the requested admission/day(s) is not/or are no longer medically necessary because: After review of the clinical information provided by North Shore University Hospital -Manhasset, the Medical Director has denied your admission to North Shore University Hospital - Manhasset. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 58 year old male, with a pre-authorized outpatient procedure on 09/02/2015 for a cardiac catheterization with an intervention, which was converted to an inpatient level of care. Based on the Interqual criteria (a decision based program to determine medical necessity) this procedure does not require an inpatient level of care, therefore, it does not meet criteria.

Urgent treatment is important to stop further damage and treat the injury, so get immediate medical help!

Avoidable emergency department (ED) encounters places a significant burden on the health care system. Seniors 65 years or older have the highest rate of hospital encounters of any other age group (Bulut, Yazici, Demircan, Keles & Demir, 2015). The Center for Medicare and Medicaid (CMS) have placed stiff penalties on hospitals that are not able to reduce repeat encounters (“Coordinating better care & lowering costs”, 2017). These penalties result in the loss of guaranteed funding if the hospitals are not able to reduce readmission rates. Therefore, hospitals are seeking solutions to solving this challenge (“Coordinating better care & lowering costs”, 2017). Care transition teams are in place to help mitigate repeat encounters,

Hospital readmission is an avoidable healthcare issue. Pedersen, Meyer&Uhrenfeldt (2014) “defined hospital readmission as a return to hospital shortly after discharge from a recent stay”. When most patients leave the hospital, the intent is not for a reappearance in the hospital again soon. But, many discharged hospital inpatients get readmitted sooner than 30 days from their initial discharge. Some readmissions are projected or could be as a result of natural cause. Other patient readmissions due to lack of hospital quality care could be an avoidable readmission.

The good intentions to improve the quality of health care sparked financial initiatives such as pay for performance and quality bonus payments. These financially influenced methodologies do not come without unintended and ethical consequences.

Devising ways to implement strategies to reduce hospital post-discharge readmission rates of patients is vital. It has been estimated that Medicare beneficiaries in America, who are readmitted within 30 days of discharge costs $15 billion per year (Bradley et al., 2013). In particular, reducing the 30-day readmission rates of the elderly population is imperative. As nurses’ we need to be aware of the importance that communication and teamwork, among the whole inter-disciplinary team, has on client care. Further research would be warranted and should include retrospective longitudinal studies in actual healthcare settings. Moreover, this would serve as a means to assess the effectiveness in the delivery of safe and effective

Are our patient’s culture, language barrier, education level, and poverty factors leading them into early hospital readmissions?

As an individual who cares about health, including the Aspen Idea Festival and formerly employed at Prevention, I would like you to consider this thought, the way patients our educated before a hospital discharge must be reconsidered.

Post-Acute Care (PAC) facilities have different reporting guidelines looking at the data set for the Home Health Agency (HHA) that provides services such as personal care by home health aides, skilled nursing care, physical therapy, speech therapy, and occupational therapy in the patient’s home.

How do we improve the quality and efficiency of health care within the U.S. with a special emphasis on improving coordination of care within hospitals?

For those who have been in the hospital or cared for a loved one in a hospital setting, it can be a traumatic, challenging experience. The same is true for those living on the streets, who tend to experience a variety of medical challenges.Recuperative medical care is designed to provide short-term medical care to homeless persons who are suffering from acute illness or injury whose conditions would be exacerbated by living on the street or in a shelter. And whose conditions can worsen by living on streets. Attending to these needs while living on the streets is extremely difficult. In addition, inadequate meals, lack of sanitary facilities, and an inability to maintain a schedule can turn a manageable condition into a life-threatening one. Recuperative medical care helps these individuals find the health and the strength

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.

On March 2, 2016 at approximately 2013 hours Security Officer Tom Mejia and Shift Supervisor Steven Evans responded to dispatched call for a 51D (Disorderly Patient in ED) to Emergency Room #42. It was reported that the patient was intoxicated and was attempting to leave. On arrival, E.D. Registered Nurse Camila Perez explained that the patient, Ms. Shayna Patkotak (FIN: #85305794) was indeed intoxicated and was wanting to leave but she was back in her room. Ms. Shayna was verbal about wanting to leave and smoke but the medical staff was able to get her to comply with them. Security stood by while the medical staff attended to her. We did not have to go hands on and there were no injuries to the staff during this incident. All cleared, nothing