Reducing Hospital Readmissions

Creating strategies to improve hospital readmission rates is essential for all post-acute care providers. The rate of readmission within 1 month of being discharged from a hospital to an acute care facility is reportedly as high as 20% among Medicare beneficiaries, costing the US health care system more than $17 billion each year. Hospital readmissions also place older adults at greater risk of disruption in care and of experiencing negative sequelae.

It has been estimated that the majority of hospital readmissions occuring within 30 days are avoidable. Therefore, it is important for post-actue care providers to identify the root causes of such avoidable readmissions, including identifying the residents most at risk and taking steps to mitigate the identified risk factors.

Staff training is an important component of such mitigation strategies and can prevent problems such as poor transitions between facilities, medication reconciliation errors, confusion surrounding post-discharge accountability, and follow-up care. In this issue of Annals of Long-Term Care: Clinical Care and Aging, two articles emphasize the vital role of staff training in addressing issues that contribute to avoidable hospital readmissions.

The Centers for Medicare and Medicaid Services (CMS) has identified several high-risk diagnoses commonly leading to readmissions. Penalties for readmissions due to myocardial infarctions, heart failure, and pneumonia have been established beginning in 2013, and since 2015, for total knee and hip arthroplasties and chronic obstructive pulmonary disease (COPD).

Roy J Goldberg, MD, CMD, FACP, AGSF reports the outcomes of an initiative to reduce re-hospitalization by identifying patients with complex illnesses identified as posing an increased risk of potentially avoidable recidivism, educating staff about readmission prevention strategies, and implementing these strategies to prevent readmissions from occurring. Using the Interventions to Reduce Acute Transfers (INTERACT) readmission tool, readmissions were regularly reviewed to look for the root cause in an attempt to decrease the risk of readmission for similar future cases that may be potentially avoidable. Interventions were then designed and implemented in an attempt to minimize the risk of readmission for these patients. 

Heart failure (HF) is the leading cause of hospitalization and readmission for Medicare beneficiaries. Approximately 20% of long-term care (LTC) residents have a diagnosis of HF. Compared with Medicare beneficiaries with HF residing in the community, LTC residents with HF have more medical comorbidities, significantly higher mortality rates, and an increased risk of hospitalization.

Noting the importance of the certified nursing assistant (CNA) in recognizing early HF exacerbation symptoms identified in current evidence-based practice guidelines for HF management in LTC, Jennifer Kim, DNP, GNP-BC, FNAP, et al conducted a 3-month pilot quality improvement project using a pre-post design that included an educational intervention for CNAs and conducted by a nurse practitioner. The three aims of the project were to: (1) improve CNAs’ knowledge of HF management strategies; (2) improve CNAs’ reporting of acute changes in the condition of residents with HF; and (3) reduce rehospitalizations of the facility’s skilled unit residents with HF.

The percentage of HF resident 30-day hospital readmission rates fell 7.8% during the project’s 3-month implementation period. The results of this project support future NP-led clinical education for CNAs working in this facility.

Reducing the rate of hospital readmissions not only saves money but also means improved quality of care and quality of life. Increased focus on patients with complex care needs as well as improved staff training may contribute to reducing 30-day readmission rates.