Transcript Effectiveness of an Admissions Unit in an Academic Medical

Reaching Out to Reduce Readmissions
William C Crowe, Jr, DNP, APN, ACNP-BC, FNP-BC; Paul M Smith, RN; Jodi Whitted, MSSW, LCSW
Erlanger Health System, Chattanooga, TN
INTRODUCTION
With the initiation of CMS penalties
for excessive readmission rates,
hospitals have attempted to
institute programs and methods to
assist patients to avoid unnecessary
readmissions. Excessive hospital
length of stays are not feasible to
prevent readmissions, and thus
hospitals and physicians are tasked
with both preventing readmissions
and reducing length of stay.
BACKGROUND
The groundwork for reducing
readmissions at Erlanger started
several years previously as a pilot
project for only those Medicare
patients diagnosed with
Congestive Heart Failure. Based on
the success of the pilot program,
the project expanded to cover five
additional diagnoses for the
Medicare population, and has
further plans to expand a second
time to include all Medicare
patients regardless of the
diagnosis.
PURPOSE
The purpose of the project was to
reduce the number of avoidable
readmissions while minimizing
the financial impact of
governmental readmission
penalties.
METHODS
Erlanger Health System partnered
with a Community Based Care
Transitions Program (CCTP) which
provides an in home visit within
the first few days of discharge from
the hospital. During this visit, the
CCTP coach assists the patient with
appointments, medications, and
discharge instructions, as well as
education on symptoms that
require physician notification.
Following the in home visit, the
CCTP coach contacts the patient via
telephone weekly for the next
three weeks.
For those Medicare patients not
eligible for the CCTP program, a
nurse from Erlanger calls the
patient weekly during the 30 days
following discharge. The nurse
assists the patient with
appointments, medications,
transportation, and other needs as
well as providing education on the
disease process. The nurse
performs telephone triage for
those patients with symptoms and
makes recommendations for
additional follow up and
interventions.
Medicare patients are visited in the
hospital prior to discharge by the
hospital’s Care Transition Team
which provides an additional
opportunity for education and for
explanation of the CCTP coach and
Nurse Coaches.
FACTORS IMPACTING
READISSIONS at EHS
160
Medication Issues
• Prescriptions not filled
• Medications not taken
correctly
Follow Up Issues
• No PCP appointment
• Unable to keep PCP
appointment
Instructions
• Did not understand discharge
instructions
• Missing written discharge
instructions
120
147
140
VOLUMES
123
112
CCTP
100
Call Center
97
80
67
60
57
52
46
42
40
37
34
29
20
0
January
February
March
April
May
June
25
Readmissons
20.59
RESULTS
Readmission rates are not
significantly different between the
Call Center and the CCTP coaches,
indicating that effective
interventions to decrease
readmissions are possible without
in home visits. Based on the
success of the Call Center
interventions, the Call Center
expanded and is in the process of
expanded further to reach all
discharged Medicare patients.
Additionally, the CCTP doubled the
number of coaches making in home
visits.
The program’s largest successes
have been with AMI, which
dropped from a baseline
readmission rate of 11.8% to 5.3 %
and with pneumonia, which fell
from 21.2% to 8.8%
.
20
A3D
Call Center
13.79
14.29
15
13.51
11.94
13.04
12.37
12.92
12.28
11.61
11.56
9.76
10
5
0
January
February
March
April
May
June
CONCLUSIONS
For a small department, the task of
reducing readmissions can seem
overwhelming. By evaluating each
readmission thoroughly, and seeking
out the cause of the readmission,
trends can be identified and acted
upon in order to reduce avoidable
readmissions.
As the CCTP was a community
resource, all three major acute care
hospitals participated, which has
allowed the hospitals to work
symbiotically to prevent avoidable
admissions.
Post acute discharge facilities have
also become involved, and work with
the CCTP and local acute care
hospitals to better coordinate care
and prevent avoidable admissions.