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A Hidden Cause of Readmissions Comes to Light

Cheryl Clark, for HealthLeaders Media, February 13, 2014

"But it's really hard to show that adhering strictly to these processes of care is able to have any real influence on reducing these infections or VTE events," Hawn says. That's because the measures themselves have been "dumbed down," and lack specificity.

For example, the VTE SCIP measure to prevent pulmonary embolism or deep vein thrombosis, "is a very blunt measure. It looks at the first or second day to see if the patient got VTE prophylaxis. It doesn't look at whether they got it for the entire hospitalization, or whether they got it after discharge, or whether they were stratified into a high risk group."

She adds that while these measures are written in a way to make them simple for hospital surgical teams to report, they don't measure whether the team "tailored the measure to the complexity of the patient."

In an invited commentary, Elizabeth Hechenbleikner, MD, and Elizabeth Wick, MD, surgeons at Johns Hopkins Hospital, agreed, saying that these measures "are more complex to execute well than it may seem."

Hawn says the "focus needs to be on really assessing readiness and criteria for discharge, figuring out who the high risk patients are, and maybe doing more wrap-around services with those patients, with home health, and see if those strategies an reduce complications."

She adds, "We need to study every readmission of a surgical patient in the light of their previous admission, and ask, 'Okay. Was there something— anything—we could have done differently?' "

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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.