Hospital readmissions, a consequence of fragmentation of care, has recently been described as a crisis of health care safety, cost, and patient experience. Reducing unplanned readmissions is especially challenging. Despite the emergence of a variety of best practices, the evidence for interventions that result in meaningful improvement remains scanty.
We used best practices gleaned from the Commonwealth Fund/Institute for Healthcare Improvement's STAAR (State Action on Avoidable Rehospitalizations) Initiative and Project BOOST as a basis to develop and implement a multidisciplinary standardized discharge process to reduce unplanned readmissions.
Between October 2009 and March 2010, we convened a multidisciplinary team of hospitalists, nurses, and case mangers to develop consensus on a standardized discharge process and to train staff on 2 pilot nursing units dedicated to general medicine and heart failure (HF) care. The standardized process includes: an assessment on admission of each patient's readmission risk and post‐discharge home needs; a structured discharge preparation and patient and family education using the “Teach‐Back” and “Ask Me 3” tools; a body weight scale for HF patients; a postdischarge appointment at the time of discharge; a postdischarge telephone call from a nurse based on the discharge unit to assess the patient's clinical status, medication, and appointment issues and understanding of the key elements of the hospitalization and to address questions; and for high‐risk and HF patients, a home visit with a visiting nurse the day after discharge. As shown in Figures 1 and 2, in the 4 months following the onset of the program, the 30‐day all‐cause readmission rate decreased by 36% on the general medical unit (Fig. 1). On the medical unit dedicated to medical and heart failure patients, the readmission rate decreased by 41% (Fig. 2). Readmission rates were not seen to decrease significantly on other general medicine or cardiac units.
A standardized, multidisciplinary discharge process using risk assessment, structured education, established postdischarge appointments, a scale for HF patients, a postdischarge telephone call by a nurse from the discharge unit, and a post‐discharge nurse visit at home can substantially reduce unplanned hospital readmissions.
W. Whitcomb ‐ Society of Hospital Medicine, employment; R. Sittig ‐ none; D. Rose ‐ none; J. Fitzgerald ‐ none
To cite this abstract:Sittig R, Rose D, Fitzgerald J, Whitcomb W. A Standardized Discharge Process to Reduce Unplanned Hospital Readmissions. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 208. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/a-standardized-discharge-process-to-reduce-unplanned-hospital-readmissions/. Accessed March 31, 2020.