A pilot project focusing on avoidable rehospitalizations has so far cut readmissions among congestive heart failure patients by 15 percent at a Chicago hospital.
Leslie Zun, chairman of the Emergency Medicine Department at Mount Sinai Hospital in Chicago, detailed his hospital’s readmissions plan Jan. 27 at the World Congress 3rd Annual Leadership Summit on Hospital Readmissions in Falls Church, Va.
Mount Sinai, a 430-bed hospital, is made up of about 20 percent Medicare patients and 60 percent Medicaid patients. The rest of the hospital’s payer mix includes 12 percent self-pay patients and 8 percent patients with commercial insurance. The hospital serves patients with high rates of cardiovascular disease and obesity, low high school graduation rates and high unemployment.
When the hospital launched its readmissions plan in July 2010, it had “limited resources” to work with.
“We had no new staff or dollars to carry out a readmissions initiative,” Zun said.
Despite that, Mount Sinai was the first hospital in Illinois to launch Project RED, a patient-centered approach to discharge planning and discharge education. Short for “Re-Engineered Discharge,” the program was originally developed by Boston University Medical Center through research funded by the Agency for Healthcare Research and Quality, an arm of the U.S. Department of Health and Human Services, to create a standardized process for discharging patients.
Mount Sinai first studied the results of Project RED with congestive heart failure patients. From July 2010 to January 2011, Mount Sinai saw 34 readmissions among congestive heart failure patients, a rate of about 19 percent. After project RED was implemented – from February 2011 to July 2011 – the hospital saw only 5 readmissions among those target patients, a readmission rate of about 4 percent. That’s a nearly 15 percent reduction in readmissions.
Of the 39.5 million hospital discharges that occur across the country every year, 19 percent of patients have an adverse event after being discharged and 20 percent of Medicare patients are readmitted within 30 days. It’s commonly known that among Medicare and Medicaid patients, readmissions cost the U.S. healthcare system $15 billion annually, with $12 billion of that being avoidable.
Zun said at Friday’s conference that one of the major drivers of avoidable readmissions is that patients don’t understand or follow their discharge instructions.
“We don’t commonly tell them when to come back and when not to come back [to the hospital],” he said. “We’re not good about talking to patients about their disease states as a partner in their health.”
Zun highlighted eight different approaches and their potential to cut down on readmissions:
- Early post-discharge follow up: home visits, increased clinic visits, telephone contacts – 12 percent reduction in readmissions.
- Front end load: increased number of physician visits in immediate post-discharge period, intensified coordination with providers – 23 percent reduction in readmissions.
- Remote monitoring: nurse telemanagement, nurse hotline support, automated monitoring of vital signs – 14 to 55 percent reduction in readmissions.
- Nurse-led transition care: use of nurses as coaches, clinical specialists and patient educators – 33 percent reduction in readmissions.
- Improved patient education and self-management – 21 percent reduction in readmissions.
- Patient centered care – end of life care, high use rate during last 6 months of life, 40-50 percent reductions.
- Disease management and case management – 19 percent reduction in readmissions.
- Multidisciplinary team management – 20 to 25 percent reduction in readmissions.
Using existing hospital staff members, Mount Sinai launched the Project RED model, targeting patients with congestive heart failure. The hospital began integrating a patient advocate into the discharge process, coordinating a post-acute follow-up visit and conducting medication reconciliation.
But before implementing any new approaches, Zun said first the hospital staff members were assigned clear roles and responsibilities.
“We first needed to figure out what everyone is doing in relation to patient,” Zun said. “What we found was that no one was really coordinating the care and services.”
To address this problem, Mount Sinai created discharge coordinators, or patient advocates, to target high-risk patients when they are hospitalized, educate patients and their family about medications and treatment options, and coordinate all discharge activities with patients, including scheduling any follow-up appointments with a primary care physician, specialists, nutritionists and social workers. Emergency department physicians, the nursing staff and pharmacists also play separate but equally important roles in the discharge process.
Email
Print
Reprints/Licensing
Comment