Organization Suburban Hospital Johns Hopkins Medicine Solution Title Impact on readmission rates of psychiatric patients following pharmacist discharge counseling in a community hospital Program/Project Description, including Goals: What was the problem to be solved? The behavioral health unit at a small community hospital in Maryland was experiencing greater than normal readmissions within 30 days of discharge. The problem led to increased cost for patients and the hospital, as well as decrease in quality of life for the patient and their family. Patient s safety was also at risk due to readmissions and the many causes which led to them returning to the hospital. Below you will see the high number of readmissions caused by mental health and substance abuse related issues. 30-Day Readmission by Major Diagnostic Category at Initial Hospital Stay for Medicaid Recipients Age 21-64, 2007 Major Diagnostic Criteria Readmission Rate Circulatory System 10.4% Mental 11.8% Respiratory System 11.4% Digestive 10.3% Alcohol/Substance Abuse 13.0% How was it identified? Through data collection of readmissions within the past year, it was noticed that there had been a gradual increase in readmissions. Also, comparing the readmissions to nearby hospitals as well as statewide/nationwide readmission rates, there was a clear irregularity in the number of readmissions experienced by our small hospital in the behavioral health unit. What baseline data existed? We had access to the readmissions of the past year. We also collected patient demographics and a multitude of data to establish possible causes of readmission. Below is the data collection sheet utilized for evaluation for each patient. Data Collection Sheet Data Patient #1 Patient #2 Patient #3 Date of Admission Date of Discharge Date of Birth Medical Record Number Age Sex Primary Cause of Admission
Left Against Medical Advice? Length of Stay Counseling by Pharmacist? What were the goals how would you know if you were successful? The goal of the project was to reduce readmissions in the behavioral health unit utilizing pharmacist discharge counseling to provide medication education to patients. The project would be a success if we saw a reduction in readmissions within 30 days of discharge at the end of our 6 month study. The secondary goal was to determine what patient population was at higher risk based on their primary indications of admission to ensure they receive extra education in an effort to reduce their readmissions. Process: What methodology or process was used to develop the Solution? Discussions with the nursing team and psychiatrists led to the development of our project and its implementation. With the assistance of nurses, we were able to ensure that patient being discharged received appropriate counseling and education. Solution: What Solution was developed? How was it implemented? At first, two solutions we thought up. The first being in-person discharge counseling and the second being follow-up phone calls three days after discharge to ensure patient had access to medications. The second solution was not fully implemented as the nursing team was not able to call all the patients due to the increase in volume of discharges. The first solution of discharge counseling was implemented with nurses contacting the pharmacist and informing them post-rounds of any discharges. Pharmacist would then review medications and have a counseling session with the patient prior to discharge, including questions about adherence and social/lifestyle modifications which can be implemented to ensure they are not readmitted. Listed below are the topics discussed during each counseling session. What brought you here? What are some stressors in your life? Do you think those stressors have resolved? What medications were you taking prior to admission? Assess non-pharmacological therapy Educate about their pharmacological therapy Explain medication clinical pearls o Indication o Timing of medication o Potential side effects Answer any questions the patient may have regarding their medications/discharge plan Measurable Outcomes: What are the results of implementing the Solution? Provide qualitative and/or quantitative results to data. (Please include graphs, charts, or tools). The number of readmissions within 30 days reduced drastically with pharmacist counseling compared to those who were not counseled.
250 200 205 203 Number of Patients 150 100 50 0 2.4% Readmitted 5 13.2% Readmitted Readmissions Not Readmitted Readmissions Not Readmitted 31 Counseled n=210 We further stratified it based on the admitting diagnosis of patients to determine who was at highest risk of readmission. Admitting Diagnosis for All Discharged Patients Substance Abuse, 51 Suicide, 31 Not Counseled n=234 Major Depressive Disorder, 193 Alcohol Abuse, 107 Bipolar, 78 n=572 Schizophrenia/ Psychosis, 112
Admitting Diagnosis for Readmitted Patients Suicide, 1 Substance Abuse, 14 Major Depressive Disorder, 12 Schizophrenia/ Psychosis, 8 Alcohol Abuse, 19 Bipolar, 5 n=59 Sustainability: What measures are being taken to ensure that results can be sustained and spread? The nursing unit will be implementing better education to patients on discharge as well as utilizing pharmacists more for patients with difficulties or known history of non-adherence. Through the project, we created handouts for patients to take home regarding their medications and this information will ensure patient knows how to properly take medications and hopefully reduce readmissions which were caused by lack of information. For substance abuse and alcoholic patients, nursing staff will provide extra information on Alcoholics Anonymous and Narcotics Anonymous meetings to patients who need this information. Role of Collaboration and Leadership: What role did teamwork and collaboration play in the Solution? What partners and participants were involved? The pharmacy team, nursing team and psychiatrists worked closely to make this project a success and improved patient safety. Was the organization s leadership engaged and did they share the vision for success? All parties involved played an active role in the success of this project and they shared a primary goal of reducing readmissions and providing patient education. How was leadership support demonstrated? Continuous meetings were held throughout the project and each group shared leadership responisbilities when reporting updates to each other.
Innovation: What makes this Solution innovative? The solution was innovative because it entailed a specific population and allowed collaborative efforts among the different healthcare teams. What are its unique attributes? This solution was unique as it allowed pharmacy the opportunity to take lead and provide counseling to a patient population who normally does not receive the same education opportunities as other units. Working with the behavioral health patients made this project unique, as did the disease states they were admitted with. Contact Person Vicky Shah Title Clinical Pharmacist/ Assistant Professor at Wilkes University School of Pharmacy Email Vicky.shah1085@gmail.com Phone 847-826-0834