"Many readmissions may be due to clinical deterioration of disease, new medical problems, a planned readmission because of a staged procedure -- things that are outside the control of the medical system or outside, potentially, the control of the patient or their family," says Dr. John Lynch, vice president and chief medical officer for Barnes-Jewish Hospital in St. Louis.
“Many readmissions may be due to clinical deterioration of disease, new medical problems, a planned readmission because of a staged procedure — things that are outside the control of the medical system or outside, potentially, the control of the patient or their family,” says Dr. John Lynch, vice president and chief medical officer for Barnes-Jewish Hospital in St. Louis.
In a blog post last year, the Centers for Medicare and Medicaid Services reported that readmissions within 30 days of being discharged from a hospital dropped in 49 states and the District of Columbia between 2010 and 2015, declining 8 percent nationwide during that period — or an estimated 565,000 fewer readmissions. (The readmission rate in Vermont remained unchanged.) CMS has levied hundreds of millions in fines against hospitals as part of a program established by the Affordable Care Act to reduce readmissions. Supporters say financial penalties have led to meaningful decreases in costly avoidable hospital readmissions and helped improve quality of care. Critics say hospitals serving sicker patients with more complex medical care needs and those serving a disproportionate share of low-income patients who have more difficulty accessing ongoing care are unfairly penalized.
But even as debate continues, hospitals across the country are doing their due diligence to keep patients healthy after they’re discharged — and reduce the likelihood they’ll need to come back unnecessarily. Those efforts focus on everything from making sure patients are taking the right medications, as prescribed, not only throughout their stay but after they go — sometimes giving patients the option to get a month’s supply of medications at the hospital before discharge — to facilitating a fluid hand-off to outpatient care after patients leave.
However, it’s not only hospitals and health providers patients see after discharge that can help reduce readmissions. Patients and their families can also take steps to cut preventable readmissions. Here are some takeaways to do just that, based on strategies hospitals are employing:
Be aware of the risks associated with leaving the hospital. “Understand that a hospitalization is a high-risk endeavor and that you generally don’t recover to your normal health state on the day after discharge,” Lynch says. Instead recovery can take many days, weeks or longer. “During that time period, you’re vulnerable to having new problems develop or to falling off track.” Experts recommend patients see a primary care provider or another health provider with the patient’s whole health picture within a week of the hospitalization — and often sooner, even within two or three days of the visit, particularly for patients with more complex medical issues like multiple chronic conditions.
Get a written discharge summary. This should cover care delivered in the hospital and provide clear instructions on what patients should do after they leave. “That discharge summary needs to be written in terms that a patient can understand,” says Dr. Cynthia Deyling, chief quality officer at Cleveland Clinic, something the academic medical center and affiliated hospitals have worked to do in an effort to reduce readmissions. After all, when you’re in the hospital, “It’s a time of stress and anxiety — a very vulnerable time,” she notes. Adds Anthony Warmuth, enterprise quality administrator at Cleveland Clinic: “Even the most health literate patient in those times is going to miss things through the verbal instruction.”
Request a written summary and instructions if they’re not offered prior to discharge, and clarify anything that you don’t understand about your care plan going forward. Make sure you understand what the discharge plan is and where follow-up care is going to occur, emphasizes Dr. Gary Noskin, chief medical officer at Northwestern Memorial Hospital.
Raise any and all questions and concerns you have. In interviewing hundreds who have been readmitted to Cleveland Clinic, it’s clear patients are often very deferential in regards to what’s happening to them in the hospital, says Dr. Nirav Vakharia, associate chief quality officer and physician lead for reducing readmissions at Cleveland Clinic. When it comes to the all-important business of your care and health — or that of a loved one — he says clinicians want to hear from patients about their questions and concerns. “I think our general advice is for patients to speak up — to understand that they have a voice,” Vakharia says.
Get — or offer — support. Experts say having a family member or another trusted advocate during a hospital visit, including while receiving discharge instructions, can be critical as a patient tries to process everything. “Having a care partner involved [who] can hear and ask questions at the same time is also very valuable,” Warmuth says. In addition to advocating for a patient’s interests, that person may pick up on questions or gaps in a doctors’ instructions that a patient might miss.
Choose wisely if you’re going to a nursing home or specialty hospital. A lot of patients don’t go home from the hospital, notes Dr. Jeffrey Glasheen, chief quality officer at University of Colorado Hospital and UCHealth, based in Aurora, Colorado, but instead need short- or long-term care at a skilled nursing facility or a specialty hospital. Like other hospitals and health systems, as part of its overarching effort to reduce readmissions and improve outcomes for patients, the University of Colorado Hospital is developing partnerships with these types of organizations, Glasheen says.
Patients have a choice, as to where they go for short- or long-term care after leaving the hospital, so it’s important to do your research. Check out publicly available information on nursing homes, like Nursing Home Compare on Medicare.gov. And ask health providers at the hospital you’re at about the hospital readmission rates associated with individual nursing homes you’re considering, Warmuth says.
Make sure you’re crystal clear on medications. A point of emphasis in hospital efforts to cut avoidable readmissions is getting straight what medications a patient should be taking when they arrive at the hospital, throughout their stay and when they depart. Be sure to get all questions about prescribed medications answered before leaving. In some cases you may be able to fill prescriptions on site; especially consider this option if you have limited pharmacy access outside the hospital or aren’t sure if you’ll be able to fill them promptly after discharge.
Very commonly, clinicians stress, patients don’t take medications as recommended — or even understand what they should be taking, which can have dangerous consequences. “The patient and the family should make sure that they understand their medication regimen, and the potential side effects from the medicines or any drug interactions,” Noskin says. Talk openly too about any other barriers — like cost — that might prevent taking prescriptions, so you can discuss suitable alternatives, such as taking generics or drug discount programs.
Make sure you know who to call. Before you leave the hospital, make sure you have a point of contact, Glasheen says. A hospital’s general number isn’t enough. Most often the point of contact should be a primary care provider, but it could also be a specialist, like a cardiologist who’s providing ongoing care for a heart problem. Especially as hospitalists — physicians dedicated to in-patient care — are becoming increasingly common in American hospitals, Noskin says it’s important to know who a patient will be following up with after they leave the hospital. Many hospitals also have nurse navigators, social workers or other professionals who can help guide patients after they are discharged — particularly for those with many care needs and patients who face social or economic challenges, such as a lack of transportation or difficulty paying for care.
Above all, stay engaged, experts stress, in the hospital — and out.