"He asked that I take a detailed list of medications, including information like whether it was coated or long-acting pills, what form the patient was used to," she explains. "We want to be able to manage their comorbidities and not disrupt that ongoing care, but also to provide the pain medications our patients will need. That list is evaluated preop and provided to the hospital staff so that we know what to discharge the patient with."
MetroWest also determined that its bariatric patients' pain management was a leading cause of readmissions. In 2014, MetroWest implemented an initiative designed to make it easier for patients to comply with their discharge instructions regarding all medications.
"All medications, instead of being in pill form, are now in crushed, liquid, or chewable form for the first two or three months postop," Prentice explains. "We realized that patients were having a difficult time with the pills, with swallowing or with the medication upsetting their stomach, and so they weren't taking the pain medications the way they needed to. The resulting pain sometimes led to readmission." The improved partnership with the pharmacy is a primary reason that the readmission rate at MetroWest is low, she says, with no readmissions in the past 16 months.
Stanford also makes sure that the patient's postop medications are available in the clinic at the time of discharge. That helps ensure the patient begins the medications without any delay from going to a pharmacy.
Success key No. 5: Address hydration effectively
When the Stanford team analyzed its data on readmission rates to find the causes, hydration issues emerged as a leading factor: Patients would become dehydrated after surgery and that would lead to other complications and hospitalization. MetroWest came to the same realization, and now both organizations put more emphasis on hydration during patient education. At both facilities, patients are presented with branded water bottles and taught to carry them at all times.
That effort was to prevent dehydration, but Morton and his team also thought there was a better way to treat it.
"If you just bring them into a clinic or an infusion center, they can be hydrated and sent on their way. They don't require full admission," Morton says. "We make every effort to treat them outside the hospital if they just need hydration, but to do that we have to detect it before the dehydration causes other problems."
Gregory A. Freeman is a contributing writer for HealthLeaders.