As hospitals work to reduce readmissions, healthcare experts are looking at why patients return to the hospital and strategizing ways to keep discharged patients from becoming inpatients again, according to U.S. News & World Report.
1. Rapid follow-up. Congestive heart failure patients are some of the patients who have the highest risk of early hospital readmission, and patients who see a physician soon after their hospital stay or receive a follow up from a nurse or pharmacist are less likely to be readmitted, a study published in Medical Care found.
After researchers looked at about 11,000 heart failure patients discharged over a 10-year period, they found the timing of follow-up is closely tied to readmission rates, said study co-author Keane Lee, MD. "Specifically, it should be done within seven days of hospital discharge to be effective at reducing readmissions within 30 days," Dr. Lee said.
2. Empathy training. When clinicians are trained in empathy skills, they may better communicate with patients preparing for discharge, and encouraging two-way conversations may help patients reveal their care expectations and concerns. Providers at Cleveland Clinic, for example, receive empathy training to better engage with patients and their families.
3. Treating the whole patient. When a patient suffers from multiple medical conditions, catching and treating symptoms of either condition early may prevent an emergency room visit. Integrated care models make it easier to give patients all-encompassing, continuous care, said Alan Go, MD, director of comprehensive clinical research at the Kaiser Permanente Division of Research in Oakland, Calif.
4. Navigator teams. A patient navigator team of a nurse and pharmacist can help cut heart failure patient readmissions. Patients who are discharged may be overwhelmed by long medication lists and multiple outpatient appointments. A patient navigator team of a nurse and pharmacist can help cut heart failure patient readmissions.
One study examined results of these teams at New York City-based Montefiore Medical Center. The navigator team helped reduce 30-day readmission rates by providing patient education, scheduling follow-up appointments and emphasizing patient frailty or struggle to comprehend discharge instructions.
5. Diabetes home monitoring. For high-risk patients with diabetes and coronary artery disease, home monitoring can help avoid readmissions. In a study examining a Medicare Advantage program of telephonic diabetes disease management, nurses conducted regular phone assessments of patients' diabetes symptoms, medication-taking and self-monitoring of glucose levels. The study found hospital admissions for any cause were reduced for the program's patients.
6. Empowered patients. It is critical for patients to understand their care plan at discharge, including medications, physical therapy and follow-up appointments, said Andrew Ryan, PhD, professor of healthcare management at the University of Michigan School of Public Health in Ann Arbor. "Patients don't want to be readmitted, either," Dr. Ryan said. "They can take an active role in coordinating their care. Ideally, they wouldn't have to be the only ones to do that."
7. Proactive nursing homes. "There are very high readmission rates from skilled nursing facilities," Dr. Ryan said. If a recuperating resident developed a health problem, traditionally, they were immediately referred to the hospital. "Now, hospitals are doing some creative things, like putting physicians in nursing homes, where they [make rounds] and try to figure out what could be treated there and what really requires another admission," Dr. Ryan said. "It speaks to this interest in engaging in care in a broader sense than hospitals historically have."
8. Nurses on board. A program putting nurse practitioners and RNs in about 20 Indiana nursing homes is seeing success in cutting preventable hospitalizations among residents. The OPTIMISTIC project, or Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care, reduced hospitalizations by one-third, a November 2017 report found. OPTIMISTIC allows on-site nurses to give direct support to patients and educate nursing home staff members, sparing frail older adults from the stress of hospital admissions and readmissions.