Becker's Clinical Quality & Infection Control

52 QUALITY IMPROVEMENT & MEASUREMENT 8 ways hospitals are cutting readmissions By Megan Knowles A s hospitals work to reduce readmissions, healthcare experts are looking at why patients return to the hospital and strat- egizing ways to keep discharged patients from becoming inpatients again, according to U.S. News & World Repor t. 1. R apid follow-up. Congestive heart failure patients have some of the highest risk of early hos- pital 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 re- admitted, a study published in Medical Care found. Researchers looked at about 11,000 heart failure patients who were discharged over a 10-year period and found the timing of follow-up is closely tied to readmis- sion rates, said study co-author Keane Lee, MD. "Spe- cifically, 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. Encouraging two-way conversa- tions may also 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 emer- gency 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 readmis- sions. Patients who are discharged may be over whelmed by long medication lists and multiple outpatient appoint- ments. 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 for heart failure patients 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 coronar y arter y disease, home monitoring can help avoid readmissions. In a study examining a Medi- care 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 un- derstand their care plan at discharge, including medica- tions, 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 coordinat- ing their care. Ideally, they wouldn't have to be the only ones to do that." 7. Proactive nursing homes. "There are ver y high read- mission rates from skilled nursing facilities," Dr. Ryan said. If a recuperating resident developed a health prob- lem, 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 tr y 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 practi- tioners and RNs in about 20 Indiana nursing homes has seen success in cutting preventable hospitalizations among residents. The OPTIMISTIC project, or Optimizing Patient Transfers, Impacting Medical Quality and Improv- ing 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 mem- bers, sparing frail older adults from the stress of hospital admissions and readmissions. n "Patients don't want to be readmitted, either. They can take an active role in coordinating their care." -Dr. Andrew Ryan, professor of healthcare management at the University of Michigan School of Public Health in Ann Arbor

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