Readmission rates are top of mind for many hospital and health system leaders as Medicare penalties for high rates of preventable readmissions loom. St. John Hospital and Medical Center in Detroit is projected to incur $2.5 million in penalties in 2013 due to readmissions. To reduce readmissions and prevent future penalties, the IPC hospitalist group at St. John began a two-phase initiative that involves filling prescriptions before patients are discharged and ensuring early follow-up with primary care providers. While readmissions are a complex issue, these relatively simple interventions reduced the IPC hospitalist group's 30-day readmissions at St. John by 27 percent in only nine months. The interventions were subsequently adopted by the hospital and its readmission rates were also significantly reduced.
Phase 1: Filling prescriptions prior to discharge
The first phase, which began in Oct. 2011, involved coordinating with the hospital pharmacy to fill and deliver prescriptions to the patients' bedside. In addition, social workers at the hospital used department funds to help pay for medications for patients who otherwise could not afford them.
Phase 2: Following up with primary care providers early
In the second phase, which began in April 2012, hospital staff made appointments for patients to visit their primary care physician within two days of discharge. St. John Hospital used this strategy because an analysis of hospital readmissions showed that approximately 20 percent of readmissions occurred in the first three days post-discharge. Ensuring patients followed up with their primary care physician early prevented patients from needing to return to the hospital.
"The key to the success of this project was simplicity," says Osama Nunu, MD, a practicing hospitalist with IPC The Hospitalist Company who led the initiative. Having simple interventions helped gain buy-in from physicians and staff. Implementing the interventions in two phases facilitated the transition to a new process and enabled leaders to identify which intervention was responsible for the effect; in this case, both interventions led to the readmission reduction.
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Phase 1: Filling prescriptions prior to dischargeThe first phase, which began in Oct. 2011, involved coordinating with the hospital pharmacy to fill and deliver prescriptions to the patients' bedside. In addition, social workers at the hospital used department funds to help pay for medications for patients who otherwise could not afford them.
Phase 2: Following up with primary care providers early
In the second phase, which began in April 2012, hospital staff made appointments for patients to visit their primary care physician within two days of discharge. St. John Hospital used this strategy because an analysis of hospital readmissions showed that approximately 20 percent of readmissions occurred in the first three days post-discharge. Ensuring patients followed up with their primary care physician early prevented patients from needing to return to the hospital.
"The key to the success of this project was simplicity," says Osama Nunu, MD, a practicing hospitalist with IPC The Hospitalist Company who led the initiative. Having simple interventions helped gain buy-in from physicians and staff. Implementing the interventions in two phases facilitated the transition to a new process and enabled leaders to identify which intervention was responsible for the effect; in this case, both interventions led to the readmission reduction.
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