The right care at the right time

There are many factors that go into ensuring patients who are discharged from the hospital following a medical procedure don’t end up right back in the hospital.

Results from a new study published in the Dartmouth Atlas of Health Care spelled out a few surprising causes for readmissions. It turns out that one big factor is timing, which causes many patients to miss out on critical information about their home care instructions.

Traditionally, hospitals provide discharge instructions when patients are preparing to leave, which study participants said was often the worse time to do it. That’s because they say there are often too many external factors that prevent them from retaining their care information.

Fixing this hurdle and others will be a huge benefit for both patients and hospitals. One report suggests that patients spend more than $17 billion a year in avoidable Medicare bills alone.

Now, with a renewed focus on reducing readmissions as a result of the Affordable Care Act, hospitals across the country are springing into action to prevent being hit with huge Medicare fines.

For a little more than two years, Oak Brook based Advocate Health Care has taken bold steps in transforming its approach to care delivery. Recognized as one of the top health systems in the nation, Advocate’s new care model AdvocateCare, which focuses on prevention and coordination of care, has helped the system improve patient care and control costs.  The model consists of 70-plus care managers who deliver hands-on, personal care to high-risk patients that reduces readmissions and shortens their lengths of stays in the hospital. These care managers also help physicians with patient follow-up care including staying connected with patients after hospital discharge to ensure they are following home care instructions.

These efforts are paying off and beginning to tick down readmissions at its hospitals.

Researchers also looked at several other health systems that are employing similar and different techniques to help prevent hospital readmissions.

Nurses at Oregon Health & Science University are teaching heart failure patients what they’ll need to do at home on their first and last day in the hospital.  In Salt Lake City, they find that employing teach back techniques are really paying off with patients.

Hospitals taking these efforts say everyone benefits when you work to reduce hospital readmissions, the country, which is saddled in staggering debt, the hospitals by cutting out unnecessary wastes in the system but most importantly the patients—who receive great care, outstanding health outcomes at a reduced cost.