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A Hidden Cause of Readmissions Comes to Light

Cheryl Clark, for HealthLeaders Media, February 13, 2014

Serious complications resulting from surgery are only now attracting attention as a cause for hospital readmissions. That may be because some surgeries will soon be included in Medicare's 3% readmissions penalty algorithm.

Amidst all the frenzy to prevent 30-day readmissions, some hospital teams may be surprised to learn that they've been neglecting an important and apparently hidden source of these preventable costs.

That source of readmissions is serious complications from surgery.

And it is only now attracting attention, perhaps some surgeries are now included in the 3% readmissions penalty algorithm, and more are anticipated.

A report out this week shows a surprisingly high number of surgical patients developing these complications, such as a venous thromboembolism (VTE) or infection, after discharge. Many of these patients require a return to the hospital for life-saving and expensive care, researchers at the University of Alabama Birmingham have discovered.

Such complications are known and reported, but the focus has been mainly on complications discovered during the initial hospital stay.

"The thing that surprised us most was the proportion of complications that were happening after the hospitalization," a large share of which resulted in the patient's return, explains Mary Hawn, chief of gastrointestinal surgery at the University of Alabama Birmingham and the senior author of the report, published online in Wednesday's JAMA Surgery.

"If we're just using the end of the index hospitalization to assess our rates of complications, we're going to miss a lot of these complications that are likely attributable to that surgical procedure," she says.

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3 comments on "A Hidden Cause of Readmissions Comes to Light"


Kate Toomey (2/20/2014 at 2:02 AM)
An element missing is the key role a SNF can play as a partner in reducing rehospitalizations by ensuring at risk patients receive appropriate care until they are safely ready to go home. Our Central Massachusetts facility ended our last quarter with an 8.3% rehospitalization rate compared to Central Mass average of over 21% and the State over 23%.

Kathleen Dowis (2/19/2014 at 3:43 PM)
CMS is targeting hospitals in areas that they have little or no control, for readmission penalties in an effort to further decrease reimbursement. You can provide all the resources available, but you should not have to be responsible for how a patient chooses to adhere to recommendations/teachings once they leave our care. Unless they are proposing that hospitals start making house calls for the first 30 days after discharge. We are constantly being set up for failure by the regulatory agencies.

G. J. Johnson DHA MSN RN (2/15/2014 at 9:24 AM)
This article highlights what nurses have said for years. Patients cannot be shoved out the door so quickly that a proper assessment, patient and family teaching, arrangements for community services, and modifications to the living environment are lacking. The follow up after discharge falls through the cracks and patients are merely instructed to see their Primary Care Physician or surgeon. No one sees the patient until the patient takes the initiative, and the patient is quite obviously a poor judge of when to seek timely intervention. We need more community-based follow up. Hospitals should invest in nursing services to follow the patient and maintain contact until the person is totally convalesced or placed in a facility. In other words, we need to increase the number of RN case/care managers and home health nurses if readmissions are to be reduced.