Reducing Bariatric Readmissions
About two-thirds of the readmissions are preventable, one expert estimates. Identifying patients most at risk for readmission and focusing on best practices proven to keep patients out of the hospital can help.
This article first appeared in the January/February 2016 issue of HealthLeaders magazine.
With a mortality rate of 0.1% and relatively few complications, 30-day readmissions represent the one area in which bariatric surgery programs could improve, says John Morton, MD, director of bariatric surgery at Stanford (California) University School of Medicine and immediate past president of the American Society for Metabolic and Bariatric Surgery. Improving that rate requires identifying patients most at risk for readmission and focusing on best practices proven to keep patients out of the hospital.
John Morton, MD
About two-thirds of the readmissions are preventable, he says, and the most common reasons for readmission are dietary indiscretions and medication reconciliation.
Focusing on those two causes and other best practices enabled Stanford's bariatric program to reduce its readmission rates from 8% to 2.5% in four years. Stanford's 2008 pilot project on reducing readmissions evolved into the nationwide Decreasing Readmissions through Opportunities Provided program, which aims to reduce 30-day readmissions nationwide
"One thing that got my attention was a letter from an insurer saying that if our admission rate was above 5% we wouldn't be allowed to participate in the network anymore," Morton says. "I knew we had a problem, and we started looking at our data to find out what was wrong."
Success key No. 1: Identify at-risk patients
Identifying the patients most at risk of readmission early in the process will go a long way toward lowering readmission rates, Morton says, and that can guide whether the procedure is performed inpatient or outpatient. One rule of thumb is the 50/50 rule, which says a patient is at risk for readmission if the age or body mass index is greater than 50. A patient who has an established relationship with a primary care physician is at lower risk, he explains, because that doctor can help coordinate care.
Severity and comorbidities also can put a patient at risk for readmission. A hemoglobin A1c of 10% or the presence of more than three comorbidities should be a readmission warning sign, Morton says. Insurance status also plays a role, with Medicare and Medicaid patients more likely to be readmitted.