Reducing Hospital Readmissions

While doing research for this topic, I came across an interesting and anonymous quote: “There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Everybody blamed Somebody when Nobody did what Anybody could have done.” Although not all hospital readmissions are avoidable, I thought this quote nicely summarizes what sometimes happens in long-term care concerning hospital readmissions.

There is no doubt that coordination of care across resident conditions, various services, health care settings, and over the course of time is one of the greatest challenges in health care today. Senior care exists within an already fragmented system of health care, which complicates the matter of hospital readmissions. Hospital discharge planning is one of the most important elements of continuity of care for persons leaving the hospital and returning either home or to a care facility. I always suggest that administrators, directors of nursing and social workers in long term care get to know their local case managers and discharge planners.

Facts, Figures and the Rest of the Story

What are some of the reasons behind increased hospital readmissions? Medication errors play a major role as do medical errors that take place in the care facility. Absence of follow up care is another reason for high readmission rates. Poor communication is probably one of the most common causes of readmission. These and many other factors lead to higher 30, 60 and 90 day readmission rates, greater use of the hospital emergency room and escalating medical costs.

What we need is seamless care, or do we need coordinated care transitions? How about good care continuity, care coordination or just plain old case management? Whatever we call it, we need better communication and planning to reduce hospital readmission rates and care for residents where they live.

The Institute for Healthcare Improvement provides a lot of good information. It has been estimated that over 600,000 Medicare beneficiaries are admitted to long term care facilities annually. There are roughly 5 million hospital readmissions every year. One-third of readmissions occur with 90 days of discharge from the hospital and 46% could be prevented. That is nearly half! Between 15% – 25% of all Medicare hospitalizations are re-hospitalizations which costs Medicare over $15 billion annually.
Since Medicare began collecting data on readmissions, senior care facilities have joined forces with hospitals to develop committees and coalitions to monitor and reduce readmissions. Much has been discovered over the past few years about which health conditions are responsible for high readmission rates. Roughly 20 health conditions account for almost 60% of all episodes of care, including, diabetes, CHF, COPD, renal failure, fractures and bacterial lung infections.

Readmission is one of the indicators of hospital performance. The lower the score the better it is for the hospital, and eventually the skilled nursing facility. Now more than ever, hospitals and nursing facilities are engaged in reviewing admissions, readmissions, and inappropriate admissions. By reducing unwarranted readmissions, Medicare can save billions of dollars that can be put to better use somewhere else in health care.

Final Thoughts

The bottom line is that we in senior care need to provide excellent nursing and medical care. If we can keep our residents out of the hospital and treat them where they live, wouldn’t that be much better? The use of care pathways, care maps, or other standards of care can help reduce readmissions. At the very heart of this topic is good nursing care. Perhaps this is what we need the most.

More About Leadership

• Leadership in Health Care: The Truth and the Bull
• Workplace Bullying in Health Care
• Improving Communication in the Workplace
• Understanding and Using the Law of Attraction
• Building a Better Team
• Workplace Success and the Power of Trust and Genuine Relationships