- Three communities in New York State saw a dramatic drop in the number of preventable 30-day readmissions among their Medicare populations after focusing on better planning and communication during transitions of care. During the 19th Annual Institute for Healthcare Improvement (IHI) Scientific Symposium on Improving the Quality and Value of Health Care, research presented by IPRO, New York State’s Medicare Quality Improvement Organization (QIO) showed that instituting uniform procedures for common issues such as medication reconciliation and self-management for patients after discharge were effective in keeping patients out of the hospital.
Nearly one in five Medicare patients returns to the hospital within thirty days of discharge, a statistic that has become the poster child for quality improvement in hospitals. With more than three quarters of these rehospitalizations the result of preventable circumstances, providers have scrambled to identify areas of improvement to keep financial penalties at bay. IPRO sat down with several healthcare communities in New York to help providers share their experiences and best practices surrounding readmissions reductions.
The groups found that there were four major issues that often led to readmissions: a lack of communication among providers and between the provider and the patient, poor reconciliation of multiple drug regimens, the inability to exchange health information in a timely, electronic manner, and a failure to educate patients about self-care programs to follow at home.
After providers codified procedures to follow when comparing medication plans, communicating critical information, and teaching patients how to manage their own care, readmissions across three participating communities dropped from an average of 32.53% to 25.75%, demonstrating a 20.8% relative improvement. “These latest results confirm that by working with IPRO in a concerted, collaborative effort, New York’s healthcare community can significantly improve care and reduce rehospitalizations,” said Clare B. Bradley, MD, MPH, Senior Vice President and Chief Medical Officer, IPRO.
Other recent research has shown that nearly a third of physicians blame hurried or incomplete hand-off procedures for an adverse event during hospitalization. “Traditionally, doctors are trained in medical school to interview a patient and write daily summaries of the care plan but though vital to patient care, [they] rarely receive communication or handoff training,” said lead author Amy J. Starmer, MD, MPH, from the Division of General Pediatrics at Boston Children’s Hospital, where the study took place. When trained in the use of a mnemonic device and EHR tool to help prompt more thorough communication, physicians were able to cut the number of preventable adverse events in half and significantly reduce medical errors.