Becker's Hospital Review

15 CLIC and engaged with the voice agent," he said. "But in a perfect world, that would have precluded our nurse from connecting with other patients and really addressing the topic at hand." At any point in the call, patients can request to speak with a nurse. About 40% of patients answer the call and 30% complete the call with the AI agent. ose 30% of patients have about a 5% lower readmission rate than patients who do not complete the call, Mr. Nelson said. While the AI isn't perfect, it quickly determines whether a patient prefers a brief or lengthy conversation. e voice agents also closely mimic human speech patterns and response times, he said. Labor costs for post-discharge calls are about $375,000 for 14 UHS hospitals. e AI tool is at a similar price point, but expansion to all 29 hospitals is expected to yield a net gain. Reducing readmissions will generate more savings, as UHS readmission penalties are in the millions, Mr. Nelson said. MUSC Health (Charleston, S.C.) MUSC Health, an 18-hospital system, takes a multi-pronged approach to improve the discharge process. At MUSC Health Charleston (S.C.), telehealth medication reconciliation appointments are scheduled for patients with acute kidney injury or chronic obstructive pulmonary disease — conditions with high morbidity and mortality risks and low medication adherence. Pharmacy interns from the Medical University of South Carolina schedule the appointments within 24 hours of discharge. e system also uses virtual nurses to handle admissions and discharges, allowing bedside nurses to focus on direct care, according to Erik Summers, MD, chief medical officer of MUSC Health's Charleston division. Discharge expediters, or nurses who bring patients to the discharge lounge and address barriers, support the process further. To maintain focus, discharge data is published biweekly for each floor, helping everyone — not just front-line staff — be accountable. "e people on the front lines have to see that leadership is focused on discharge," Dr. Summers said. "And it's not just saying discharge early, which is about the worst thing it can do, sending out an email saying, 'Discharge faster.'" To improve access, MUSC Health aims to place the right patient in the right bed at the right time. In November, the Charleston division was at about 300 bed days per month — capacity created by moving appropriate patients to other settings. "You take 300 a month, you divide that by 30. I'm no math genius, but I think that's 10 extra [beds available per day]," he said. "Boy, that matters. at matters when you have 20 or 30 boarders in your ED every day." UK HealthCare (Lexington, Ky.) UK HealthCare launched a care coordination initiative — the Local Integration of Navigation with Kentucky (LINK) — to reduce readmissions by connecting inpatient and outpatient settings. Jay Grider, DO, PhD, chief quality officer of UK HealthCare and CEO of Kentucky Medical Services Foundation, called the effort an "ambitious process." rough a population health navigation care platform, the system targets patients with an Epic readmission risk score between 30 and 55. Patients with a risk score above 55 are likely too sick for the system to make significant progress in reducing readmissions, Dr. Grider said, while those below 30 are unlikely to be readmitted. From there, UK HealthCare broke down this patient population into four groups: heart failure, gastrointestinal disorders, endocrine disorders and pulmonary disease. LINK initially centered on a discharge clinic model. While a discharge clinic now exists and sees patients within 48 hours, the model could not effectively scale. UK HealthCare then pivoted to focus efforts within internal primary care, achieving about a 1 percentage point reduction in readmissions. Now in its second phase, LINK 2.0 targets at-risk patients who do not receive primary care from UK HealthCare but are oen readmitted. It also aims to improve discharge planning and strengthen trust between EDs and ambulatory providers. "So how do we take somebody and say, 'OK, they are readmitting at a clip that is much more frequent. We have to have them stabilized with an appointment [with a specialist] three days, four days out,'" Dr. Grider said. "at's tricky to do in our setting, but we are starting to work on those processes now with our internal medicine group." Preliminary data shows another 0.9% reduction in readmissions, moving UK HealthCare closer to the median among Vizient members. Becker's asked Dr. Grider how it feels to be working on LINK 2.0. "It feels like LINK 1.0 didn't work," he said, laughing. "I can tell you lots of ways not to prevent readmissions, and that's really the story of my career. My career is a 'what not to do' but with an occasional, 'Oh, that worked.'" n "The people on the front lines have to see that leadership is focused on discharge. And it's not just saying discharge early, which is about the worst thing it can do, sending out an email saying, 'Discharge faster." - Dr. Erik Summers

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