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Fresh Take on Hospital Discharges Cuts Readmissions

Cheryl Clark, for HealthLeaders Media, January 8, 2014

So how are they bringing about improvement in readmission rates?

Medication reconciliation

One effective strategy DMC employs involves medication reconciliation at several points during the stay, especially during any in-hospital transition, say from an ICU step-down to a floor unit.

And no patient can leave a DMC hospital without the proper reconciliation checks, not only to ensure that the patient is on the right medications but also to be certain the patient understands what these drugs are supposed to do and how they should be taken. That means making sure old medications are designated in the medical record as having been removed, to avoid represcribing the wrong drugs. That's a mistake the hospital used to make, she says.

It's been a "huge challenge," White says, but hospital officials have inserted a kind of hard stop into the system's electronic medical record. The system "doesn't allow you to print the discharge papers until the medication reconciliation has been completed."

DMC's efforts to ensure that the right drugs are taken frequently includes what DMC calls its First Fill program, in which the hospital dispenses the first several days' worth of medications for patients—particularly those going to nursing homes. "That's so patients actually have their proper medications before they leave the hospital" and so staff can help patients understand what each one is supposed to do and how to take it.

"This is an area where there has just been a tremendous amount of activity to improve our processes," White says.

First physician visit

A review involving 4,000 admitted patients at three DMC hospitals in 2010 has revealed what White calls a "dramatic, very tight" correlation between all-cause readmissions and one simple thing: the timing of the first physician appointment after the patient left the hospital.

"We discovered that the rate of 30-day readmissions correlated perfectly with the number of days between the patient transitioning out of the hospital and when they saw their primary care physician," she says.

If the patient saw the doctor between day one and day four after hospitalization, the chance of readmission would be less than 6%. If the appointment was on the 6th to the 10th day after hospitalization, chance of readmission was between 6% and 13%. And for visits with the doctor on day 25, the chance went up to 29%. "The readmission rate increased by 1% for every additional day between discharge and the first physician visit," she says.

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