5 Core Concepts to Reduce Readmissions

In a session at the Becker’s Hospital Review annual meeting in Chicago on May 18, Erik Heckerson, RN, MA, FACHE, vice president of operation performance with TeamHealth and Jasen Gundersen, MD, MBA, CPE, SFHM, chief medical officer of TeamHealth discussed ways hospitals can reduce readmission rates.

Mr. Heckerson opened the session with addressing the problem of growing readmission rates. He noted that 71 percent of hospital experience reduced Medicare payments because of readmissions. Spread nationwide, that’s $15 billion in lost payments. Moreover, three-quarters of readmissions are preventable.

“There is a readmission crisis,” Mr. Heckerson said.

Dr. Gundersen then presented what TeamHealth considers five core concepts that will help hospitals reduce readmission rates, which include:

1. Recognition. It’s crucial for hospitals to recognize potential problems that may lead to readmission. Equally important is managing patient and family expectations and providing what Dr. Gundersen called “downstream alerts.” The team of physicians caring for a patient need to be aware of potential issues and have as much information and data as possible.

2. Communication. Once recognizing any issues, the caregiving team needs to do everything in its power to avoid communication breakdowns. “Communication is imperative among the healthcare team,” Dr. Gundersen said. Poor communication may lead to misalignment of expectation and a lack of patient or family trust. It will also lead to higher readmission rates.

3. Intervention. Every point of contact with a patient is an opportunity, Dr. Gundersen said. It’s important to constantly manage expectations and provide post-acute care management.

4. Education. Any learning experience tailored to patient and families has to take into consideration social and cultural concerns, notes Dr. Gundersen. Continuous education on multiple levels with the patient, family caregivers and other care providers provides a sort of security blanket for the hospital. Physicians and staff can feel confident they did everything in their power to empower the patient and family. A useful way of teaching a patient is to use the teach-back method, Dr. Gundersen said. That is, a physician, nurse or other caregiver will confirm post-acute care instructions by having the patient tell the caregiver the instructions. Perhaps the physician asks the patient a question about when to take a particular dose of medicine. Videos that repeat instructions to patients also help.

5. Reconciliation. Dr. Gundersen notes that electronic medical records are in some ways a blessing and a curse. Medication errors happen, and when someone inputs data incorrectly in an EMR, that information is considered common knowledge until someone corrects the data. He noted it’s important to reconcile errors in EMR and confirm EMR records regularly.

TeamHealth works with hospitals on an individual level to reduce readmission rates. When putting together a plan, Dr. Gundersen said he polls people “on the ground” to find out where problems are. Starting with perhaps the chief medical officer or an overnight hospitalist might help gauge how and why readmissions are occurring.

“The night hospitalist will tell all,” Dr. Gundersen said.

TeamHealth has been able to keep all-in readmission rates at the hospitals it works with at 11 percent or below.

More Articles Related to Improving Hospital Readmissions:

Healthcare Leaders Discuss Key Concepts to Police, Improve and Measure Quality
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Cleveland Clinic Opens Simulation Center to Improve Healthcare Delivery

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