When I served as a hospital administrator, we seemed to be forever preparing for an
on-site survey by The Joint Commission, which was not a bad thing. Staying constantly
prepared is a much better approach than “cramming” at the last minute to get ready. Here
at Texas Tech Physicians, we do our best to be ready for a survey at any time (by
the way, we have one coming up this year). As we all know, it takes focus and alertness
to stay in a “ready mode” due to the general busy-ness of things. This column is not
about ongoing perseverance for an on-site survey; although, that is a good topic we
can cover another day.
Today, I am writing about one aspect of survey preparation from my hospital days:
discharge planning and the avoidance of preventable readmissions. Actually, I shouldn’t
draw a line between hospital days and now, because Texas Tech Physicians still actively
works to prevent readmissions with our hospital partners. But, in my time spent in
the hospital, I remember one particular discharge planning nurse drilling us in preparation
for an upcoming survey.
“When should discharge planning start during a hospitalization?” she would ask.
The answer, of course, is it should begin at admission and be facilitated through
discussions between the physician and patient, and sometimes, with case managers and
family members. Unfortunately, the ideal is not the norm and there is often a rush
toward the end of hospitalization when everyone agrees that it is time for the patient
to leave. Then, staff set up follow-up appointments, review home care instructions
and confirm prescriptions in a series of somewhat haphazard conversations. It doesn’t
have to be this way, but it often is. It is a shame because one-fifth of Medicare
beneficiaries are readmitted within 30 days of discharge, and one-third are readmitted
within 90 days. A well-crafted study concluded that 20 percent of patients have a
complication within three weeks of leaving the hospital, more than half of which could
have been prevented. Medicare spends $26 billion annually on readmissions, and $17
billion is for readmissions considered preventable. Preventing readmissions is clearly
a major challenge that we should meet.
Rather than describe a problem without offering solutions, let’s look at what can
be done. Working to prevent readmissions includes the simple suggestion of starting
the process early, allowing time to make sure the patient knows the times of his or
her follow-up appointments (and agrees with the times) and to carefully go over prescriptions
and home care instructions so the patient or a family member can demonstrate good
understanding. Some institutions have started using transition coaches to help. Another
good thing is to put instructions in clear, easy-to-read instructions with large print.
Finally, providing a nurse “hotline” patients can call with questions and the institution
placing a follow-up phone call to the patient to check on status have been effective
ways to reduce readmissions.
Some readmissions are unavoidable, and if a patient needs to be readmitted, they should
be. We simply need to identify the preventable reasons for readmission and learn from
that information to benefit the next patient.
