PLEASE RESPOND TO PAULA’S POST BELOW. POST MUST BE SUBSTANTIVE AND ADD TO THE DISCUSSION IN A MEANINGFUL WAY.
PAULA’S POST: A huge target of health care reform in the United States is preventing hospital readmissions. Under the Affordable Care Act of 2010, the government passed the Hospital Readmission and Reduction Program (HRRP), which penalizes excessive readmissions for patients with Medicare. Since this new legislation was passed, readmission rates have decreased. The factors that have been shown to cause hospital readmission are early discharge, inadequate support, insufficient follow-up, therapeutic errors, adverse events related to drugs and medications, failed handoff, complications, nosocomial infections, pressure ulcers, and patient falls. Due to the increasing number of elderly readmissions as SLMC, I feel a chart audit is an important first step in decreasing the rate. I would employ a case manager to be involved in all discharge planning for every patient admitted. To prevent therapeutic errors, medication reconciliation must be completed by the physician responsible for the patients care, as well as by a pharmacist to double-check for any errors in prescriptions. One way to prevent mistakes with medications being available at home would be for the hospital pharmacy to fill the prescription and discharge the patient with their medications in hand. The case manager should also be involved in scheduling follow-up appointments with the patients aftercare providers prior to discharge, so they are not lost to follow-up. They may also screen the patient for risk factors for readmission including high-risk medication use, polypharmacy, multiple chronic conditions, and specific high-risk conditions. A helpful screening tool is the LACE index, which incorporates the Length of stay, patient Acuity, degree of Comorbidities, and the number of visits to the Emergency department in the last 6 months. The Care Transitions Intervention (CTI) appoints a discharge nurse transition coach to facilitate self-management by the patient or caregiver. They help the patient develop a personal health record, obtain follow-up appointments, and instruct patients on what to do if problems arise. The coach sees the patient prior to discharge, at home 2-3 days following discharge, and gives 3 follow-up phone calls over 28 days after discharge. This intervention was shown to decrease 30-day readmission rates by almost 5% (Alper, OMalley & Greenwald, 2020).
After reading Demings 13 Total Quality Management principles, the management principle I would apply is the constancy of purpose. The purpose here is to reduce hospital readmissions and we must work constantly and with a purpose to do so to improve overall patient experience and improve outcomes.
References
Alper, E., OMalley, T., & Greenwald, J. (2020) Hospital discharge and readmission. https://www.uptodate.com/contents/hospital-discharge-and-readmission
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