Reducing Readmissions From the Postacute Setting
With skilled nursing facilities spread thin and under value-based performance pressure, hospital systems are testing new approaches to prevent readmissions.
This article first appeared in the April 2017 issue of HealthLeaders magazine.
Intermountain Healthcare, a Salt Lake City nonprofit health system with 22 hospitals and a broad range of clinics and services, found that ambulation was a key component to reducing readmission rates for complex abdominal and orthopedic surgeries. The problem was ensuring that the postacute care setting, including skilled nursing facilities (SNF) and home health agencies, would enact the ambulation protocol, says Mark Ott, MD, surgeon and chief medical director for the health system's central region, which has five hospitals in Salt Lake Valley.
"Complex abdominal surgeries such as colectomies and pancreatic resections have a high rate of readmissions because of the high-risk nature of some of these patients and the complexity of their surgical operations," Ott says. "With the ambulation protocol, we were able to cut readmissions from 15% to 7%."
Intermountain Healthcare found that patients who walked more after surgery would get out of the hospital sooner; preliminary results are that each additional walk decreased the hospital length of stay by approximately 0.17 days, and lowered rates of readmission to the emergency room or hospital by 50%, Ott says.
However, ambulating patients is a labor-intensive process, and the workload was more than the hospital nurses could handle, says Ott. He and his team worried that if hospital nurses were struggling, SNFs and patients and families at home certainly would not be able to fulfill the protocol without additional resources and help.
To shift the burden off nurses and other staff, Intermountain supplied 1,300 patients with a smartphone, loaded with an activity tracker app the health system developed with Savvysherpa, an ambulation and healthcare analytics company in Minneapolis. Patients are given ambulation goals based on their previous day's ambulation efforts. They also receive an alert when it is time to walk around, and data surrounding the activity is logged and shared with clinicians.