Readers wanting to stay on top of new developments and improve patient care will enjoy reading Patient Handoffs: Effectively Managing Care Transitions (Frontiers of Health Services Management 25(3). Chicago: Health Administration Press).  I learned that 17.6% of Medicare hospital admissions are readmissions, that acccount for $15 billion in annual expenditures.  Furthermore, 80% of these readmissions were deemed potentially preventable (p.6)

I was delighted to read that a large body of evidence supports interventions, such as a call from a nurse or physician within 72 hours of discharge, which I cited in a case report on Positive Deviance from Waterbury Hospital in Collaborate for Success! Cutting-Edge Strategies for Engaging Physicians, Nurses, and Hospital Executives (p. 117-19), that cut their readmission rate from 2 patients per month to nearly 0.

Other strategies that Maureen Bisognano and Amy Boutwell recommended in the Ideal Transition Home Model include:

• Including family caregivers and community providers in predicting home-going needs
• Using Teach-Back* to assess the patient’s and family’s understanding of self-care expectations
• Reconciling medications for discharge
• Scheduling a home-care or office visit within 48 hours of discharge for high-risk patients, such as those with congestive heart failure (CHF)

*Teach-Back is a method of presenting information and requesting patients and caregivers to restate the instructions in their own words what they heard at the bedside.  Teach-Back questions for CHF patients include:

• What is the name of your water pill?
• What weight gain should you report to your doctor?
• What foods should you avoid
• What symptoms should you report to your doctor?

Using such a protocol, St. Luke’s Hospital, Cedar Rapids, IA was able to decrease the readmission rate for CHF patients from 12% to 3-9%.  The variation resulted from patients who were near the end of life but not yet willing to engage in palliative care options.

What do you think?

• Do you plan proactively for care needs outside the hospital
• Do you test the caregivers’ understanding as well as the patient’s
• Do you see the handwriting on the wall re: payers’ eventual unwillingness to pay for readmissions regardless of cause

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn
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