Here’s one thought that should be at the top of your mind before leaving the hospital: Not going back.
About 15% of all hospital stays result in readmissions in the United States, according to data from the Centers for Medicare & Medicaid Services (CMS). These readmissions can create difficulties for patients, hospitals and the healthcare system as a whole.
Take Charlotte, for example. The 71-year-old was admitted to the hospital for two days with heart failure. Upon discharge, the hospital forgot to update the dose of her diuretic heart failure medication, and the assisted living medication management program followed protocol to give her the previous, incorrect dose. In this scenario, Charlotte developed severe swelling, requiring multiple additional days in the hospital and thousands of dollars of unnecessary medical expenses.
Asking the right questions before leaving the hospital can lessen your risk of readmission — and ensure both a healthier future and a lighter bill.
[READ: Your Rights as a Hospital Patient]
Preventing Hospital Readmissions
A hospital readmission occurs when a patient discharged from the hospital is readmitted for the same condition within a short period of time. The CMS defines a readmission as within 30 days.
Hospital readmissions are detrimental for several reasons, including:
— Putting you at risk for hospital-acquired infections, like methicillin-resistant Staphylococcus aureus (MRSA) or urinary tract infections
— Straining healthcare resources, such as nursing staff, or healthcare payers, like Medicare
— Increasing the risk of death
Questions at the hospital are encouraged — not only to prevent a secondary admission, but also to help you understand your diagnosis and treatment and to help you care for yourself after discharge.
At the same time, you might feel a little intimidated to ask questions for a few reasons:
— Everything going on during your hospital stay feels confusing or overwhelming.
— With looming surgery or inpatient treatment, you might not be thinking about life outside the hospital yet.
— You don’t feel comfortable questioning medical providers.
[SEE: What to Pack in Your Hospital Bag Before a Surgery or Procedure: A Checklist]
How to Communicate With Your Care Team
If asking how to prevent a hospital readmission feels too overwhelming, tap into resources to help you communicate with your healthcare team. As much as they enjoy seeing you, they don’t want you to come back, either.
Here are a few strategies to try:
— Request help from a caregiver. If you have a caregiver or loved one in the hospital with you, they can remind you to ask questions and take notes on the answers. Your caregiver can write questions on the whiteboard in your room, which hospital staff update each shift. If you’re not comfortable asking questions yourself, your caregiver may be able to advocate for you.
— Rely on your nurses. Nurses aren’t able to diagnose you, interpret imaging results or give you a prognosis on your condition, but they can address almost any other question, such as your plan of care, medications, treatments or resources at home. If they don’t know the answer, they can connect you to someone who does.
— Get to know your attending physician. Also called a hospitalist or doctor of hospital medicine, your attending provider oversees all your inpatient care. They also give orders to and coordinate with your nurses, dietitians, physical therapists or any other specialists you may need.
— Ask for a patient navigator. A patient navigator team, consisting of a nurse and pharmacist, can help connect you with community and medical resources to manage your condition after discharge. For example, if you are having trouble getting a cardiologist appointment, a nurse navigator might be able to help you find another clinic in the area with sooner openings or remind you to get your new prescription filled.
Once you leave the hospital, you should see your primary care doctor to help coordinate your care and check on your recovery.
[READ: 10 Tips to Prepare Your Home After a Hospital Stay]
14 Questions to Ask Before Leaving the Hospital
Below are key questions to ask before you are discharged.
1. What post-discharge medications do I need to take?
New medications or changes in your current medications will be one of the most important topics to understand post-discharge. There are a few things you’ll want to know about your medications, including:
— Dosage
— When and how often to use them
— Why you are using them
— The exact names (medications often have a generic name and a brand name, so you may not always recognize the name of a medication that you already use)
— Any side effects
— How to take the medication (such as with water or with or without food)
— Whether you’ll need the medication over the short term or long term
— Whether the prescriptions are already called into a pharmacy, or if you’ll need to make sure that they’re ordered
— What to do if you miss a dose of your medication
2. What was the exact reason or cause for my admission?
You may have been too busy recovering to fully understand why you were admitted in the first place. Learning why can help you prevent the same circumstance from recurring.
Diabetes, for instance, has one of the highest readmission rates leading to death, according to the Endocrine Society. So, if you were admitted to the hospital because your diabetes was uncontrolled and you had dangerously high blood sugar levels, ask what changes you need to make at home to avoid running into the same issue.
3. Were there any other diagnoses made during my stay?
You may go into the hospital because of a bad asthma attack, but doctors end up diagnosing you with high blood pressure, for instance. Asking about additional diagnoses will potentially trigger other questions to help your at-home care.
You should also ask if you have any “comorbid” conditions, which is a fancy way of saying a patient has more than one health problem. When a patient has both diabetes and heart disease, for example, catching and treating symptoms of either condition early may stave off a trip to the emergency room.
4. Have you notified my primary care doctor about my admission?
Your primary care provider is the liaison between all of your resources and specialists for your condition. Keeping them in the loop makes sure the whole team is on the same page.
Ideally, you should have a follow-up visit with your primary care provider within a few weeks post-discharge. It can be a virtual visit in some cases. However, if the admission was due to something like an infected wound, it would be best to have the visit in the clinic.
5. Which specialist doctors do I need to follow up with?
Depending on your diagnosis, you may have seen other specialists, such as a cardiologist or pulmonologist (lung doctor). You’ll want to know if you need to see these specialists in the future.
“Follow-ups are crucial for the post-hospital care. Many times, patients assume that these follow-ups will be made by hospital staff, and that is generally not the case,” says Dr. Tiffany S. Di Pietro, a cardiologist in Fort Lauderdale, Florida.
6. What red flag symptoms mean I should call a doctor or return to the ER?
Make sure you know the “red flag” signs and symptoms that should prompt you to seek medical care again. Examples of red flag symptoms with specific conditions include:
| Condition | Red Flag Symptom Examples | Immediate Action Needed |
| Heart failure | Weight gain of 2 pounds or more in 24 hours, sudden shortness of breath, increased swelling in your legs | Call a cardiologist or seek urgent medical evaluation |
| Diabetes | Confusion, extreme thirst, blood sugar levels greater than 300 mg/dL that won’t drop after insulin | Seek immediate emergency care |
| Heart attack, cardiac event or stroke | Chest pressure, pain radiating to your arm or jaw, sudden numbness or weakness in your face or arm, slurred speech, sudden dizziness | Call 911 immediately |
| Surgical or wound care | Redness spreading from the wound, a fever of 100.4 degrees Fahrenheit or higher, foul-smelling drainage | Contact your surgeon’s office immediately |
7. Do I need any other follow-up lab work or imaging?
Your doctor may order a follow-up scan or lab test during your stay, such as:
— Labs to make sure your new medication dose isn’t negatively impacting your electrolytes
— A follow-up echocardiogram after a heart attack
You can ask the hospital if they are able to help you schedule and coordinate any of these follow-up studies.
8. Will I need physical therapy, speech therapy or home healthcare?
You also may need physical, occupational or speech therapy. Your hospital healthcare team can let you know exactly what you need and help you identify where to find this care.
Some home monitoring programs, for conditions like diabetes or coronary artery disease, allow medical professionals to continue to keep in close contact without you having to go into the clinic. Registered nurses conduct regular comprehensive phone assessments on symptoms and medications, and they can help you understand how to take care of yourself at home. They also focus on comprehensive care, such as exercise, nutrition, sleep and stress.
9. How long should my recovery take?
There can be a big difference between a one- or two-day recovery versus a recovery over several weeks or months. Recovery may take longer if you have more severe medical problems, such as heart or lung conditions.
10. What should I do if my home health agency doesn’t contact me?
This question helps you know when you need to make an extra push to get your appointments scheduled. Home health and other agencies are often inundated with paperwork and appointments, so staying proactive about making sure you have an appointment will reduce the risk of a hospital readmission.
11. What dietary or activity restrictions should I follow at home?
You will be able to have a smoother recovery if you know how to approach movement and nutrition post-discharge.
For example, after being admitted for acute kidney failure, you want to make sure you know how to adopt a more kidney-friendly diet before you’re discharged. Or, if you went to the hospital due to a fall, ask about how to slowly increase your activity.
12. How do I get a copy of my hospital discharge records?
“I always encourage my patients to obtain a copy of their pertinent medical records. This way, there is less error from patient recall and less post-hospital communication errors,” Di Pietro says.
When requesting your medical records, Di Pietro suggests asking for:
— Lab results
— Imaging
— Hospital notes, such as admission and progress notes
13. How will I pay for my hospital visit?
Whether you have insurance or you’re self-paying, there’s a whole other set of questions that you may have about the cost of your hospital stay. A hospital social worker or financial assistance staff member can speak with you about the costs involved.
Depending on how you’re feeling, this may be done once you’re back home versus in the hospital.
If you have insurance, try to find out these costs in advance to make sure they are affordable for you. If they aren’t, your healthcare team can suggest alternatives or let you know about medication assistance programs. The same applies to covering the cost of equipment, such as a walker or wheelchair, you may need.
14. Am I being discharged home or to a rehabilitation facility?
Not everyone is discharged back home. You may need to go to rehabilitation care or senior living, such as assisted living or a skilled nursing facility.
If you are going home, make sure you ask about how to set yourself up once you are there:
— Will I need anyone to help take care of me when I am home? What types of tasks will I need help with? Is this appropriate for a family member to help with, or can you connect me to a home health agency?
— How soon can I drive once I am home?
— Do I need to modify parts of my home to make it safer? Modifications could range from a minor adjustment, such as keeping a pill organizer on your nightstand to remember your new medications, to installing a shower grab bar to prevent falls.
If you are being discharged to another type of short or long-term care, make sure you talk to your medical team about which option or facility they recommend. Make sure to ask if the facility is suited for your diagnosis and has a way to help you manage your medications and treatment plan.
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14 Questions to Ask Before Leaving the Hospital to Avoid Readmission originally appeared on usnews.com
