Within our ever changing world of healthcare the need for spine surgeons to direct their focus on lowering the rates for hospital readmissions is on the rise. Hospital readmissions are more commonly being used to gauge standards of care and the Centers for Medicare and Medicaid Services (CMS) is now utilizing readmissions rates to decrease reimbursements for specific care/procedures rendered. In order to identify and understand methods that can be used to decrease hospital readmissions, it is important to recognize the difference between a planned and unplanned readmission. Planned readmissions are when you actually stage or reschedule a patient's procedure or they are a direct transfer (for example to a rehab facility). Unplanned readmissions are a result of either a surgical or nonsurgical complications (commonly an infection). Unplanned readmissions are more likely to be influenced by change initiatives therefore spine surgeons should direct their focus on decreasing the prevalence of unplanned hospital readmissions. It is known that many unplanned readmissions are unavoidable; as a significant number of readmissions occur within 30 days of a procedure due to an error that occurred during the patient's first visit/procedure. Here are four tips to help you reduce your hospital readmissions rates today. 1) Patient education. The efficiency of your patient education plays a key role in the prevalence of hospital readmissions that occur post-surgery. Many complications that result in readmission can be avoided through clear and open communication for patient education. According to the Agency for Healthcare Research and Quality (AHRQ), patients who have a clear understand¬ing of their after-hospital care instructions, including how to take their medications and when to make fol¬low-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this relevant information.
Patient education should be your top priority for reducing readmissions. Whether it is the surgeon or nurse's responsibility to sit down with the patient post-surgery to review their post-op plan of care, patient education is a must! Such education will help your patients identify what is normal to expect after their procedure, which will aide in stopping them from unnecessarily going to the emergency room if they see a small drop of blood at the site of their incision.
Patient education should begin at your first visit pre-procedure; the more informed your patient is about their procedure, needed medications and their healing process, the better! Remember that when it comes to ensuring comprehension of post-op education you need to have a clear understanding of your patient's literary intelligence, understanding of medical terminology and the English language. Knowing this about your patient will help you communicate more effectively, therefore they will be able to learn more effectively.
When patients are released from the hospital they should know exactly what medications and continued care is necessary for their recovery process. This can be achieved by sending your patients home with a customized list. This list should describe in easy-to-understand language the purpose of each medication and when it should be taken. You can also include a "red flag" trouble shooting list that identifies signs to watch for that may lead to a to complication that requires follow up care.
2) Accessibility of office staff to triage. Part of the patient education process includes providing your patients with a contact person and phone number to call in order to answer any post-op questions that arise. Having a clinical staff member and phone number dedicated for post-op patients will help to decrease the incidence of your patients going to the emergency room for follow up care. By providing your surgical patients with a "Post-Op Hotline" your clinical staff will be able to triage your patient's medical concerns. Clinical staff can speak with patients to get a better understanding of the complication or perceived complication that is occurring, and they will be better able to inform patients as to whether: A) this is a normal occurrence and to continue with their plan of care, B) they need to come into the office to be checked out by the physician, or C) if it is a true medical emergency where they need to go directly to the hospital for care.
3) Discharge planning/ home care services. Before a patient is released from the hospital, a thorough discharge plan must be in place to ensure continuity of care in the home. At this time a clear understanding of your patient's home life/support system will be needed. You should obtain information on your patients' psycho-social needs and their support systems within the community (this will help you to identify patients who are at a "high risk" for readmission). For example, if patients need a dressing change or wound care performed on their back, do they have a family member at home who can assist them as a caregiver? If so, then that caregiver should be involved with the post-operative educational training and discharge meetings. This will help to insure that follow up care is completed in a timely and accurate matter which will help to decrease the incidence of infection and therefore the incidence of being readmitted to the hospital.
You may identify an instance where your patient does not have a caregiver to provide treatment, or perhaps the post-operative care needed is so extensive that home care services will be needed. Start by identifying the needed outpatient or home care services that will be needed for their care. Does your patient's insurance cover such services? Will your patient be able to afford the needed medication and home care services? If money is an issue, help your patients get assistance and check their care plan to see if any of their treatments can be altered for a more cost effective approach. This extra support will ensure that patients are receiving their needed care and will contribute to the goal of decreasing the incidence of hospital readmissions by limiting their need to go to the emergency room.
Communication with rehab facilities and home care organizations is pertinent. Be extra careful with the coordination for outpatient care and home care services. Utilize the help of case managers and discharge planners for outpatient care to ensure quality and standards of care will be met. Sometimes during the coordination of services medication lists go missing, post-surgical care instructions may be confusing or missing. Readmissions are more likely to occur when little or no communication exists between physicians during the time that a patient is switched from one facility to another.
4) Close post-operative follow up/ home care. As well as having a "Post-Op Hotline" in place, you should also have a regular post-op follow up schedule in place. For example a nurse should be reaching out to patients within 24 hours of discharge to check in on how they are feeling. At this time they can also remind the patients about the "Post-Op Hotline" in case any problems arise later on in their healing process.
In regards to follow up appointments, they should be scheduled before a patient is discharged. Reminder calls should always be made to patients with follow up appointments to further assure that they will show up for care. It is relevant to make sure that patients attend all follow up appointments in order to prevent hospital readmissions due to complications. More intense follow up for your high risk patients may also be needed. This would include non-English speaking patients and those who are underinsured, who are the most likely populations to return to the hospital for care due to complications.