Avoiding Hospital Readmission
By Susan Rogers, MSG, Prestonwood Rehabilitation & Nursing Center
In almost 20 years of working with seniors, I have come to believe that one of the only things worse than being admitted to the hospital is being re-admitted to the hospital.
Hospital readmissions occur for several reasons. Sometimes a second, unrelated health crisis occurs causing another hospital stay. A jaunty 70-year-old gentleman I know was hospitalized after fracturing his ankle on the dance floor. Three weeks after leaving the hospital he was back, this time to receive IV antibiotics for an infected cut on his finger sustained in woodworking class.
More often, however, the cause of readmission is related to the first admission. A woman may develop pneumonia while recovering from surgery. A man may skip his follow-up appointment with his physician, thereby missing a chance to have his blood pressure medicine adjusted leading to hypertension or a stroke. A hospital may not give clear and understandable discharge instructions, resulting in a patient taking the wrong dose of medication. Or sometimes a patient’s condition will take a turn for the worse, requiring inpatient medical attention.
Almost 20% of Medicare patients are readmitted within 30 days of discharge from the hospital. Reducing this high rate of hospital readmission has recently become a major focus for medical professionals. Not only is it in the patient’s best interest to avoid subsequent hospitalizations, but now it will be in the hospital’s best interest too. Beginning in 2013, Medicare will financially penalize hospitals when patients are readmitted within 30 days.
As hospitals, skilled nursing facilities, physicians and home health agencies work together to reduce the likelihood of hospital readmission, each patient can reduce their own chance of a return to the hospital.
Understand Your Risk for Readmission
Patients with certain high-risk diagnoses are more likely to be readmitted to the hospital within 30 days. According to a study by Dr. Joseph G. Ouslander, et al, published in August 2010 in the Journal of the American Medical Directors Association, for Seniors, the diagnoses with the highest risk of hospital readmission within 30 days are: congestive heart failure (31%), urinary tract infection (28%), renal failure (27%), pneumonia (23%), and COPD (23%). Patients with more than one chronic illness are also at great risk for readmission.
Follow Up with Medical Providers
One of the best things you can do after returning home is to set an appointment to see your primary care physician within seven days of hospital discharge. Most patients are seen by a hospitalist rather than their PCP in the hospital. Sometimes information about your hospital stay is conveyed to your PCP, but often it is not. Your PCP will be more familiar with your medical history and can be sure that any new medications or treatments are right for you. It’s also important that you set and keep appointments with your specialists so that they can monitor your condition.
Be a Good Patient
Everyone hopes for a short hospital stay and a quick return home, but sometimes it is necessary to receive care and treatment in a skilled nursing facility, rehab hospital or long-term acute care hospital before going home. If your doctor recommends this level of care, it will often reduce the likelihood of hospital readmission if you take advantage of these specialized programs. Far too often I meet with patients who disregarded their doctor’s advice by going directly home from the hospital, and now have found themselves back in the hospital in worse shape.
Do Your Homework
When selecting a post-acute provider, be sure to find out what measures they will take to keep you healthy and out of the hospital. Finding a skilled nursing facility with on-call specialists such as a pulmonologist, physiologist, respiratory therapist and infectious disease and wound care specialists can mean the difference between making a quick recovery and spending more time confined in the hospital. Using a home health agency with tele-monitoring programs, which will monitor your blood pressure, weight, blood sugar and other health indicators, will often allow nurses to catch and treat symptoms before they require hospitalization.
By doing these four simple things, you can reduce your risk for hospital readmission, and give yourself the best chance for a quick and full recovery.
Author Susan Rogers of Prestonwood Rehabilitation & Nursing Center in Plano, TX holds a Master of Science in Gerontology from the University of North Texas.