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.
Readmission to a hospital creates strain and added expense for the patient and hospital; in 2011, hospital costs due to readmission were almost $41.3 billion (Hines, Barrett, Jiang, & Steiner, 2014; Rau, 2014). There are many aspects of healthcare associated with readmission, such as lack of discharge planning and education, which need to be addressed i to decrease the amount of preventable re-hospitalizations.
The health care organizations have big opportunity to improve their quality of healthcare service as well as improve life quality of customers through reducing an avoidable readmission. The readmission is defined by Centers for Medicare and Medicaid Service (CMS) “Admission to a subsection hospital within 30 days of a discharge from the same or another subsection hospital” Hoffman, J.H. (2012). Readmissions can be classified four different categories, including (1) Planned readmission which the reason of the readmission is related to the initial admission. For example, reconstructive surgery with subsequent steps or it could be series of treatment such as cancer chemotherapy. (2) Planned but the reason is not related to the initial readmission.
The biggest take-away I have from watching the Improving Transitions of Care videos is that transition of care has been and continues to be a huge ongoing problem with poor communication between the healthcare providers and the patient. As posited by Dr. Eric Coleman in the Module 1 video, we should consider one in five Medicare patients being readmitted within 30 days of discharge from the hospital as unacceptable (Joint Commission Resources [JCR], 2010). According to the video series, there are several projects being implemented to improve the discharge planning process and thus decrease the need for hospital readmission (JCR, 2010). A few of the tools being used such as, the After-Hospital Care Plan, more comprehensive teaching about diagnosis,
Reduction in Medicare reimbursements related to 30-day readmissions, have made readmission prevention a hot topic in healthcare today. In an effort to reduce our 30 day readmission rate, my hospital has invested in a software program that pulls information from over 60 sources and then calculates an “All Causes Risk for Readmission Score”, classifying patients as low, moderate, or high risk for readmission. The case managers do an in-depth assessment on all Medicare patients classified as high risk. This assessment typically takes 1-2 hours of conversation with the patient and family to complete, and addresses the patient’s medication compliance, financial concerns, social support, and living environment, and understanding of their disease
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.
My vision for this practicum project stemmed from recent reports of soaring readmission rates for Vanguard Hospital core measure patients; which include patients with a diagnosis of a myocardial infarction, congestive heart failure, and pneumonia. Preventing unnecessary readmissions for core measure patients was the topic of discussion at the monthly staff meeting that I attended. The Director of Nursing and Quality Improvement Coordinator led the discussion; which included, informing the staff of recent Medicare and Medicaid reimbursement cuts related to the increase in readmissions for these particular patients. In addition, statistical information was displayed using SHP data and the Midas Report, revealing how Vanguard Hospital and Home
The Medicare Hospital Readmissions Reduction Program (HRRP) financially penalizes hospitals with higher than expected 30-day readmission rates for Medicare patients by reducing annual reimbursements by up to 3% (AHA, 2015; Barnett et al., 2015). Most hospitals and health care systems have focused on implementing evidence-based programs to improve performance and patient outcomes in order to prevent
The clinical problem with this case scenario bring up one of many common concerns. Many hospitals today plan discharge for patients as soon as they are admitted. There are many concerns that come from this fast assumption of discharge. Planning for discharge before the patient is fully assessed by the nurse also involves fast discharge teaching, which leaves the patient and caregivers anxious and uneducated about their future. This is where the problems come into play with the nurses, patients, and caregivers. When it comes to this scenario, caregivers are scared or hesitant to have to care for loved ones on such short notice and after a brief hospital stay. This normally
The enactment of the ACA (Affordable Care Act) (2010), section 3025, prompted CMS (the Centers for Medicare and Medicaid Services) to enact section 1886 of the Social Security Act establishing the HRRP (hospital readmission reduction program) effective October 1, 2012; to include penalties/reductions in reimbursement on hospitals that display excessive readmissions (Centers for Medicare & Medicaid Services, 2014). CMS, in FY 2015, will impose penalties up to 3% on hospitals that display excessive 30-day readmissions (Centers for Medicare & Medicaid Services, 2014). Currently, CMS will assess hospitals’ readmission penalties using five readmissions measures endorsed by the National Qualify Forum (NQF): heart attack, heart failure, pneumonia,
Your outcome interest regarding readmissions of patients within 30 days of discharge from acute care is definitely an ongoing dilemma and as you mentioned there are several contributing factors that impact a successful or unsuccessful outcome. A couple of classes ago, Tammy introduced the concept of Project RED (Re-Engineered Discharge), which I am still very interested in becoming familiar with. According to the founder of this concept, Dr. Brian Jack, believes that "At the heart of many preventable readmissions lie poorly coordinated care, including unreconciled medications, still-pending test results and still-needed tests, poorly communicated discharge instructions, and rushed staff who don't have adequate time to spend with
In conclusion, we have determined that the elderly population is considered to be a vulnerable population. By focusing our nursing interventions to help eliminate some of these risk factors, we can help maintain and promote their health. Studies have shown that post-discharge nursing, using home care services, have provided to be successful in eliminating readmissions (Gruneir et al., 2011). I believe that this is one strategy, among many others, that will continue to help our patients reduce vulnerability and decrease
At least 20 percent of all patients who are admitted to a U.S. hospital are readmitted within 30 days of discharge, according to Medicare and others who’ve studied the pervasive problem of hospital re-admissions. This has led to the government in 2016 indicating that it will punish more than half of the nation’s hospitals — a total of 2,597 — having more patients than expected readmitted within a month. Undoubtedly this poses regulatory as well as financial risks to an institution’s “bottom-line”.
Allen et al. (2014) performed data review of 12 articles (evidence-based studies) to compare readmissions rates, length of stay, and use of transitional care intervention, follow-up. Providers responsible for implementation of transitional care interventions in the studies were also evaluated and in 5 of the studies transitional care was initiated by advanced practice nurses. Eleven of the 12 studies evaluated readmission rate using transitional care versus standard care. Six of these studies showed decrease readmission rates in the intervention group, 3 found no reduction, 1 demonstrated higher rates (thought to be related to VA status of patients) and 1 did not have sufficient information to make comparison. Lengths of stay and quality of life outcomes were
Fragmentation of care during the transition of older adults from hospital to home results in high rates of poor outcomes after discharge including rehospitalizations. About one-quarter to one-third of these rehospitalizations can be prevented if we focus on improving transitional care. Therefore, the period surrounding health care transitions is a potentially profitable area for mediating actions aimed at reducing unnecessary readmissions. Moreover patients and caregivers feel disgruntlement with the way transitional process happens. They also feel that their needs are not met at various levels which lead to dissatisfaction.(Naylor, 2000, 2004; Naylor et al., 2004)