2. Create a checklist for bed usage. While many hospital systems have begun to use checklists, Golden suggests that surgeons use them, too, before discharging patients. A list of questions would "force the surgeon to think about whether they were discharging the patient for the right reason," he says.
He noted that the checklist approach, which has been espoused by Peter Pronovost, MD, PhD, a professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine, has been used successfully to reduce hospital bacterial infections. Golden says those procedures also can be applied in evaluating bed usage. "By standardizing the discharge process, it becomes more likely that each patient is fully ready to be transitioned out of the hospital at the time of discharge," he says.
3. Assign transition coaches. These coaches can look especially at patients at high risk for readmission. "By standardizing the discharge process, it becomes more likely that each patient is fully ready to be transitioned out of the hospital at the time of discharge," he writes. Golden refers to previous studies that show hiring social workers to check on patients and to coach them on treatment and rehabilitation lowers the readmission rate.
4. Align a surgeon's compensation with a patient's health outcome. This would reflect the move toward value-based care. Currently, surgeons are paid for performing surgeries and having high operating room utilizations. "By incorporating readmission rates into the compensation formula, we might impact the discharge decision process in a way that would lower the readmission rate," he says.
Golden spoke with me about his proposals, but he best summarized his findings in the press release, after all. "Patient traffic jams present hospitals and medical teams with major, practical concerns, but they can find better answers than sending the patient home at the earliest possible moment," he said in a statement.