Why Preventing Hospital Readmissions Matters
Hospital readmissions occur when a patient is admitted back into an acute care center within 30 days after discharge. This metric assesses the quality of inpatient and post-discharge care, as readmitted patients often face increased mortality risks. The factors contributing to readmissions, including inadequate initial treatment, poor discharge planning, and lack of coordination with post-acute care providers, work as great markers for improvement when looking at the state of healthcare within a particular area.
Readmissions negatively impact patient outcomes and impose significant financial burdens on healthcare institutions. High readmission rates can lead to severe financial penalties and deter potential patients. To mitigate these issues, hospitals must prioritize optimizing inpatient care, care transitions, and case management. Effective discharge planning and care coordination are crucial strategies to reduce preventable readmissions and, ultimately, to ease the financial toll on the US healthcare system.
Why Hospital Readmissions Occur
Hospital readmissions can stem from a variety of factors, many of which revolve around the complexity of managing chronic or multiple medical conditions. As patients age, their risk of readmission increases due to the presence of comorbidities, polypharmacy, and the need for more substantial post-discharge social care. Mental illness further complicates the picture, contributing to higher risks of readmission.
One of the critical issues is inadequate follow-up care after discharge. When information isn’t properly handed over to general practitioners, patients, and home caregivers, the likelihood of readmission rises significantly. Further compounding the issue are the social factors that also play a crucial role; limited transportation, financial constraints, and difficulties accessing care can all lead to a return to the hospital. Additionally, demographic characteristics, such as where patients live, their health insurance status, or limited access to healthcare services, can cause delays in treatment and subsequent readmissions.
There are factors that occur directly within a hospital or care center that can also affect hospital readmission rates. For instance, improper treatment, inadequate care transfer from secondary to primary care, and ineffective social assistance plans, particularly for older adults, can prevent individuals from adequately caring for themselves and preventing further complications following discharge, warranting a need for readmission. Lastly, the pressing issue of alleviating the pressure to reduce inpatient lengths of stay can inadvertently increase readmissions. It should, therefore, come as no surprise that hospitals with manageable nurse workloads, including higher staffing levels of registered nurses, tend to have lower readmission rates.
Economic Impact of Hospital Readmissions
Hospital readmissions impose a heavy burden on the healthcare system, driving up costs and straining resources. It has been estimated that Medicare’s annual readmission cost is a staggering $26 billion, with $17 billion of that considered avoidable. These costs are driven by the need for additional diagnostic tests, extended hospital stays, and increased medication use, all on top of the further rehabilitation services and home healthcare that certain patients may need.
Beyond the financial impact, readmitted patients face longer hospital stays, higher mortality rates, and increased healthcare costs, which in turn put more pressure on hospital resources, lead to longer wait times, and contribute to a decline in the quality of care. As a result, reducing hospital readmissions has become a top priority for healthcare providers and policymakers, with many fighting to implement clear strategies to combat readmissions in the future.
Better Patient Education
Patients often leave the hospital with a stack of papers, some of which are insufferable to read. It is therefore recommended that patient information should be provided using clear, concise materials that are easy to follow, with appropriate signposting should further help be needed.
Likewise, patients need to know what medications they are taking, why they are taking them, and how to take them correctly. It’s important to provide this information using a patient-centered approach whereby patients are included in all healthcare decisions. This allows clinicians to assess a patient’s health literacy and tailor information appropriately using different resources.
A patient-centered approach is vital, ensuring that instructions are delivered in an understandable language while also considering cultural factors that might influence a patient’s approach to healthcare. It is important to assess a patient’s health literacy, which includes their ability to comprehend and adhere to hospital instructions. Utilizing various resources, such as printouts, animations, and educational websites, can be incredibly helpful in educating patients, especially those with lower literacy skills.
Clear Discharge Planning
Preventing hospital readmissions begins with clear and comprehensive discharge instructions, particularly when looking at elderly patients. Studies show that close to 80% of readmissions are preventable, most of which occur as a result of poor discharge planning.
Delays and inadequate planning can lead to worsened health outcomes and increased long-term care needs. Effective transitional care programs, focusing on coordinated care and education for patients and caregivers, have been shown to significantly reduce readmission rates and healthcare costs, improving the overall quality of life for patients and their caregivers.
Managing Medications
Patients often struggle to adhere to their medication schedules due to complexity, side effects, or simply forgetting doses. Healthcare providers can help by simplifying medication regimens where possible and providing clear instructions.
Ensuring medication appropriateness, where therapeutic objectives are likely to be achieved, and benefits outweigh risks, can significantly enhance patient outcomes. Medication review, particularly when combined with co-interventions like medication reconciliation, patient education, and professional training, significantly reduced all-cause hospital readmissions within 30 days.
Pharmacist-facilitated medication management has also demonstrated a reduction in medication errors and readmission rates in several studies. An unpublished study evaluated the impact of pharmacist-facilitated discharge education and medication reconciliation on high-risk heart failure and pneumonia patients showed a statistically significant 34% reduction in readmission rates, suggesting that pharmacists’ interventions improve patient care quality and decrease significant medication-related errors.
These outcomes can be further enhanced by identifying medication-related discrepancies upon admission and ensuring close follow-up after discharge. Multifaceted programs that include medication reconciliation, patient counseling, and follow-up by healthcare professionals have proven effective in minimizing readmissions.
Building a Support System
Social support, encompassing psychological and material resources, plays a rather crucial role in reducing hospital readmissions. High perceived social support, particularly from friends, significantly lowers 30-day readmission and mortality rates among ethnically diverse older adults, and so assessing perceived social support would offer a better reflection of readmission risk than structural factors like living alone.
Studies show that culturally diverse patients, especially minorities, benefit greatly from robust social networks, which buffer against the stresses of hospitalization. To effectively reduce readmissions, discharge planners should evaluate and enhance patients’ social support systems not only to provide additional layers of care but also to reduce the strain on the healthcare staff who would otherwise have to step up for the role.
The Adobe Way
Reducing hospital readmissions and avoiding penalties hinges on recognizing the importance of patient education through effective engagement and communication strategies following discharge. Hospital readmission rates range from 11.2% to 22.% – that’s more than a fifth of those being discharged from hospitals having to be readmitted within 30 days. With Adobe Population Health’s proprietary risk stratification, transitional care management, and the multitude of other payer-specific services, hospital readmission rates among our members have been successfully reduced to an average of 9%.
During the 30-day window after discharge, patients need clear, simple and accessible communication regarding their care instructions to address issues proactively before they worsen. Without effective communication, patients remain at high risk for readmission, and hospitals with high readmission rates will face severe penalties. Patients should be encouraged to talk to their doctors about their discharge plans and ask questions to fully understand their care instructions.