Becker's Clinical Quality & Infection Control

23 READMISSION REDUCTION Nearly 20% of Hospitalized Patients Are Released With Unstable Vital Signs By Brian Zimmerman C lose to one in five hospitalized patients are released from the hospital with vital sign instabilities, which can be linked to readmissions or death, according to a new study published in the Journal of General Internal Medicine. For the study, researchers analyzed EMR data from 32,835 patients from six Dallas-Fort Worth area hospitals. The team searched for vital sign abnormalities in temperature, blood pressure, respiratory rate, heart rate and oxygen saturation. Analysis revealed that 18.7 percent of all patients were dis- charged with one or more vital sign instability. Of the patients discharged with no abnormalities, 12.8 per- cent were readmitted or died within 30 days of discharge. The percentage of the patient population readmitted or dead within 30 days of discharge rose with the number of abnormal vital signs — 16.9 percent for one abnormality, 21.2 percent with two and 26 percent with three. Researchers also found that individuals with three or more abnormal vital signs were nearly four times as likely to die after being discharged. "At a time when people are developing complicated, black box computerized algorithms to identify patients at high risk of readmission, our study highlights that the stability of vital signs, something doctors review with their own eyes every day, is a simple, clinically objective means of assessing read- iness and safety for discharge," said the study's senior author Ethan Halm, MD, chief of the division of outcomes and health services research in the Department of Clinical Sciences at UT Southwestern in Dallas. "There's a good reason we call them vital signs." n Older Patients' Loss of Independence Linked to Higher Readmission, Death Rates By Heather Punke L oss of independence is defined as a decline in function or mobility, increased care needs at home or discharge to a nonhome destination. A study published in JAMA Surgery in July found this metric is strongly associated with readmission and death after discharge for older surgical patients. Researchers examined a group of 5,077 patients ages 65 and older who underwent surgery at 26 hospitals from January 2014 to December 2014. They found that loss of independence increased with age and was the second most important factor (behind serious postoperative complication) related to readmission, increasing risk by 70 percent. LOI was associated with a 6.7-fold increased risk of death after discharge as well. "Patient-centered outcomes such as LOI can, and should, be collected in multi-institutional data registries," the authors concluded. "Loss of inde- pendence is a potential target for intervention, and future work should move beyond its use as a factor for prognostication. To best serve the aging pop- ulation, clinical initiatives must focus on efforts to minimize LOI and better understand its association with discrete outcomes like readmission and death after discharge." n Study: Medication Reconciliation Programs Halve Hospital Readmissions — 6 Findings By Morgan Haefner H ospital readmission decreased 50 percent when pharmacists reviewed patients' medication regimens and provided counseling during transitions from hospital to home, Woonsocket, R.I.-based CVS Health Research Institute found. Researchers analyzed readmissions of more than 260 members of a national health plan hospitalized over a five-month period. Readmission rates for patients enrolled in medication reconciliation programs were compared with those not enrolled. Here are six key study findings: 1. Overall risk of hospital readmission fell from 22 percent to 11 percent for those in the medication reconciliation program. 2. Risk of hospital readmission at 30 days was reduced by 50 percent for those in the medication reconciliation program. 3. e medication reconciliation program saved $2 for every $1 spent on the program, with savings totaling more than $1,300 per person. 4. One in seven patients readmits to a hospi- tal within 30 days of discharge. 5. Sixty-six percent of hospital readmissions result from medication non-adherence. 6. Hospital readmissions cost more than $41 billion per year. n

• Cover