After Columbus (Neb.) Community Hospital staff networked with area healthcare providers, pharmacists, assisted living and nursing home facilities, the hospital reduced 30-day readmissions by about 42 percent from October 2016 to May 2018, the Columbus Telegram reports.
The Nebraska Hospital Association recently recognized the 47-bed hospital for its efforts to improve patient care, including its work with the National Partnership for Patients’ Hospital Improvement Innovation Network initiative.
The initiative aims to cut preventable hospital-acquired conditions and readmissions and consistently provide high-quality care by ensuring patients are still monitored post-discharge.
"We collaborate in a very formal way with our skilled nursing facilities, our assisted living facilities, our home-health agencies and our retail pharmacies and our primary care providers," said Nicole Blaser, RN, director of quality and compliance at the hospital. "We have regular meetings with them at the hospital where we sit down and say, ‘hey, this is confusing and not working well,' or, 'This really went great this time, let’s do that again next time.'"
The hospital uses a risk calculator to evaluate a patient's chance of being readmitted after treatment, said Becky Rother, RN, case manager at the hospital.
The calculator assesses whether patients have frequent emergency room visits, recent hospital stays, their age and comorbidities, Ms. Rother said. "We based one specifically for our hospital based on the types of patients we generally see here at our hospital," she said. "And then those high-risk patients that we identify, we as case managers follow them for a 30-day period."
That involves making frequent phone calls to patients and their primary care providers to see how the hospital can make the transition from the hospital as smooth as possible.
"We want to continually make that transition smoother from inpatient to outpatient so that the care providers that were caring for them here can get the information as needed to the folks [handling] outpatient to continue the treatment process," said hospitalist Kurt Kapels, MD.