briefopinion: Hospital Readmissions Survey EXECUTIVE SUMMARY: Purpose & Methods The purpose of this survey was to collect information about hospital readmission rates and practices. The survey was available online for a period of three weeks during which time a total of 18 responses were collected. Results Readmission Rates (Overall): The majority of respondents were from Acute Care Hospitals (94%) and facilities with 300 or fewer beds (67%). For the majority of respondents (64%), 24 hour readmission rates are 2% or less. The seven day readmission rates are slightly higher with half of all respondents (n=6) reporting rates of 5% or less. Thirty day readmission rates for the majority of respondents (53%) are 11% or higher. Readmission Rates (by Specific Diagnosis): For the majority of respondents (57%), the average readmission rate for Congestive Heart Failure is between 11% and. Readmission rates for Acute Myocardial Infarction are more variable with 29% of respondents indicating readmission rates of less than 1%, while another 29% of respondents report readmission rates for AMI between 11% and. A similar bi-modal distribution appears in the case of Pneumonia with 21% of respondents reporting readmission rates of less than, while 36% report readmission rates for pneumonia are between 16% and. Readmission Reduction Initiatives (Individual Responses): Continue to monitor diagnosis, attending / discharge physician for initial admission, and identify reasons for re-admission according to pre-determined list of codes: non-compliance, failure to follow-up with PCP, complication, etc... Readmissions team at all sites to look at data and do a critical X analysis. Started a collaborative with 17 SNF's and our hospitals to look at improvements in information, transitions, and better understand the data we are sharing collaboratively. Also have Palliative Care and Hospice transition into the SNF's. Palliative Care as part of our disease management approach to patients within the hospital. Also the case management dept has built alerts for 30 day readmits to alert the case manager who then uses documentation built to guide them in a readmissions assessment and individualized plan for each patient related to understanding medications, obtaining medications, follow up within 7-14 days of stay including securing a medical home, psychosocial eval. etc This
focus approach also allows us to collect data by facility, admitting DRG, and identify and trend what issues bring our 30 day readmits into the hospital. MOST of our READMISSIONS ARE FOR GOOD REASONS- USUALLY A DIFFERENT NEW dx. Many times pt does not like the facility they went to, after the first admission, so they request to returnwe are looking into these carefully and trying to prevent them- need more work to do with the SNF facilities. Collaboration with pt, family, phys, RN, Pharmacy and DC re: dc goals and clear understanding of goal dc date & time Use of UR second level referral STAAR participation with associated actions (e.g., identify learner, teach back efforts, units interviewing readmitted patients). Increased activity of medication reconciliation committee and health system patient education committee, increase effort for home health care referrals. Emergency Department pharm. tech to capture and review home med. list (not 24/7 though). Continued readmission committee. Expansion of staffing in palliative care program. Expansion of hospice home beds available. Expansion of telehealth program. Expansion of follow-up phone call program. Increased nursing staff education about readmissions. New tool for medication reconciliation at discharge. Expansion of hospitalist program. Implemented a CHF team to look at The 3 issues identified for CHF readmits: Medication management, primary care appt after DC within 7 days, Follow up phone call regarding Daily weights etc. Implemented new d/c guidelines for CHF patients that includes daily weight and other core measures Patient education Post hospital care evaluation--was home care following if d/c to home Looking at factor of repeat readmits from same facility (SNF) Currently we are reviewing discharge procedures and reviewing by physician to look at variations in practices. 1. Peer review process for every 7 day readmission to medical services with feedback to discharging providers 2. partnership with internal medicine and palliative care to identify patients appropriate for palliative care or hospice to receive end of life care at home Improved discharge medication patient information, improved faxed communication with PCP, improved patient CHF education, reached out to SNF's and improved nurses' knowledge at SNF's about CHF nursing management None (n=2) Comments (Individual Responses): 1) We review all readmissions and take necessary action to prevent them in the future or see if they can be made CONDITION 44 status. 2) We have few new initiatives for like CHF and Diabetes and are trying to implement telemedicine program when appropriate, to reduce readmissions and control the patients at home, and many other interventions to reduce readmission. We track readmissions for Like diagnoses but do not break out into individual disease rates. Do not have the employee base in Case management to do individual Disease management programs across the Continuum of care. We are thinking about a follow up phone call system for our top DRG with highest re-admission rate. One of these is ETOH use/abuse. Our case management department does not have a formal way to collect readmission data. Not currently tracking readmissions.
Respondent Demographics: Facility Type Long Term Acute Care Facility (LTAC) 6% Acute Care Hospital 94% (n=18) 27.78% Respondent Demographics: Facility Size 27.78% 22.22% 16.67% 5.56% Less than 100 beds 101 to 200 beds 201 to 300 beds 301 to 400 beds More than 400 beds (n=18)
Percent of Respondents Percent of Respondents 10 Overall Readmission Rates: Within 24 hours of Discharge 9 More than 2 percent 18.18% 8 7 Between 1 and 2 percent 18.18% 6 5 4 Less than 1 percent 45.45% 9.09% 9.09% (n=11) 10 9 Overall Readmission Rates: Within 7 days of Discharge More than 10 percent 8.33% 8 Between 6 and 10 percent 25.0 7 6 5 Between 3 and 5 percent 25.0 4 Less than 3 percent 25.0 8.33% 8.33% (n=12)
Percent of Respondents Percent of Respondents 10 9 Overall Readmission Rates: Within 30 days of Discharge More than 20 percent 6.67% 8 7 Between 11 and 20 percent 46.67% 6 5 4 Between 6 and 10 percent 6.67% Between 3 and 5 percent 33.33% Less than 3 percent 6.67% (n=15) 10 9 Readmission Rates by Specific Diagnosis: Congestive Heart Failure (CHF) More than 30 percent 8 7 Between 21 and 30 percent 6 5 4 Between 11 and 20 percent Less than 10 percent (n=14)
Percent of Respondents Percent of Respondents 10 9 Readmission Rates by Specific Diagnosis: Acute Myocardial Infarction (AMI) More than 20 percent 8 Between 11 and 20 percent 7 6 5 Between 1 and 10 percent 4 Less than 1 percent (n=14) ` 10 9 Readmission Rates by Specific Diagnosis: Pneumonia (PNA) More than 20 percent 8 7 Between 16 and 20 percent 35.71% 6 5 4 Between 10 and 15 percent Less than 10 percent 21.43% (n=14)