Planning a patient’s discharge the day they are admitted is important — but not enough to fix the complex bottlenecks that slow hospital throughput and lead to emergency department boarding.
These three systems are taking distinct approaches to smoothing the discharge process and reducing readmissions.
Universal Health Services (King of Prussia, Pa.)
Universal Health Services employs an AI voice agent to call patients after they are discharged, reducing readmission risks and saving hundreds of thousands of dollars. The system piloted the tool at two facilities, expanded it to 14, and then rolled it out to the medical division across all 29 acute care hospitals.
Before adopting Hippocratic AI’s technology, a variety of staff — mainly nurses and in some facilities, residents — called patients post-discharge.
Mike Nelson, senior vice president of strategic services at UHS, said the traditional process came with challenges: staff had high hourly rates, few patients would answer and the system does not use automated dialers — all resulting in unproductive phone time.
Some patients who do answer the call seek a deeper connection and want to discuss non-medical topics. While the interaction may be more meaningful, it consumes time that staff could spend on other patients, Mr. Nelson said.
“We had one patient that spent more than an hour on the phone with a Hippocratic AI agent, and the patient felt great about the phone call and engaged with the voice agent,” he said. “But in a perfect world, that would have precluded our nurse from connecting with other patients and really addressing the topic at hand.”
At any point in the call, patients can request to speak with a nurse. About 40% of patients answer the call and 30% complete the call with the AI agent. Those 30% of patients have about a 5% lower readmission rate than patients who do not complete the call, Mr. Nelson said.
While the AI isn’t perfect, it quickly determines whether a patient prefers a brief or lengthy conversation. The voice agents also closely mimic human speech patterns and response times, he said.
Labor costs for post-discharge calls are about $375,000 for 14 UHS hospitals. The AI tool is at a similar price point, but expansion to all 29 hospitals is expected to yield a net gain. Reducing readmissions will generate more savings, as UHS readmission penalties are in the millions, Mr. Nelson said.
MUSC Health (Charleston, S.C.)
MUSC Health, an 18-hospital system, takes a multi-pronged approach to improve the discharge process.
At MUSC Health Charleston (S.C.), telehealth medication reconciliation appointments are scheduled for patients with acute kidney injury or chronic obstructive pulmonary disease — conditions with high morbidity and mortality risks and low medication adherence.
Pharmacy interns from the Medical University of South Carolina schedule the appointments within 24 hours of discharge.
The system also uses virtual nurses to handle admissions and discharges, allowing bedside nurses to focus on direct care, according to Erik Summers, MD, chief medical officer of MUSC Health’s Charleston division. Discharge expediters, or nurses who bring patients to the discharge lounge and address barriers, support the process further.
To maintain focus, discharge data is published biweekly for each floor, helping everyone — not just front-line staff — be accountable.
“The people on the front lines have to see that leadership is focused on discharge,” Dr. Summers said. “And it’s not just saying discharge early, which is about the worst thing it can do, sending out an email saying, ‘Discharge faster.'”
To improve access, MUSC Health aims to place the right patient in the right bed at the right time.
In November, the Charleston division was at about 300 bed days per month — capacity created by moving appropriate patients to other settings.
“You take 300 a month, you divide that by 30. I’m no math genius, but I think that’s 10 extra [beds available per day],” he said. “Boy, that matters. That matters when you have 20 or 30 boarders in your ED every day.”
UK HealthCare (Lexington, Ky.)
UK HealthCare launched a care coordination initiative — the Local Integration of Navigation with Kentucky (LINK) — to reduce readmissions by connecting inpatient and outpatient settings.
Jay Grider, DO, PhD, chief quality officer of UK HealthCare and CEO of Kentucky Medical Services Foundation, called the effort an “ambitious process.”
Through a population health navigation care platform, the system targets patients with an Epic readmission risk score between 30 and 55.
Patients with a risk score above 55 are likely too sick for the system to make significant progress in reducing readmissions, Dr. Grider said, while those below 30 are unlikely to be readmitted.
From there, UK HealthCare broke down this patient population into four groups: heart failure, gastrointestinal disorders, endocrine disorders and pulmonary disease.
LINK initially centered on a discharge clinic model. While a discharge clinic now exists and sees patients within 48 hours, the model could not effectively scale. UK HealthCare then pivoted to focus efforts within internal primary care, achieving about a 1 percentage point reduction in readmissions.
Now in its second phase, LINK 2.0 targets at-risk patients who do not receive primary care from UK HealthCare but are often readmitted. It also aims to improve discharge planning and strengthen trust between EDs and ambulatory providers.
“So how do we take somebody and say, ‘OK, they are readmitting at a clip that is much more frequent. We have to have them stabilized with an appointment [with a specialist] three days, four days out,'” Dr. Grider said. “That’s tricky to do in our setting, but we are starting to work on those processes now with our internal medicine group.”
Preliminary data shows another 0.9% reduction in readmissions, moving UK HealthCare closer to the median among Vizient members.
Becker’s asked Dr. Grider how it feels to be working on LINK 2.0.
“It feels like LINK 1.0 didn’t work,” he said, laughing. “I can tell you lots of ways not to prevent readmissions, and that’s really the story of my career. My career is a ‘what not to do’ but with an occasional, ‘Oh, that worked.'”
