Strategies to reduce readmission are lacking in US hospitals

A review of US hospitals indicates a lack of implementation of important practices to reduce readmission rates among patients with heart failure and acute myocardial infarction (AMI), report researchers.

The greatest omissions were found in the areas of medication management and discharge and follow-up processes, writes the team in the Journal of the American College of Cardiology.

"Our findings suggest opportunities for continued improvement in communication and care coordination, which may assist in hospital efforts to reduce readmission rates," say Elizabeth Bradley, from Yale Public School of Health in New Haven, Connecticut, USA, and co-researchers.

High readmission rates are associated with low patient satisfaction and large financial burden to Medicare in the USA, they explain.

The team reports that while the majority (89.9%) of the 537 surveyed hospitals agreed or strongly agreed that they had a written objective to reduce preventable readmission rates, just over half (54.0%) reported having a dedicated quality improvement team in place to reduce preventable readmission after AMI.

Furthermore, just 37% and 36% of hospitals reported having a process to alert outpatient physicians of a patients' discharge within 48 hours, and a process to follow up on test results returned after discharge, respectively.

This finding suggests that hospital and professional cultures tend to focus on the inpatient part of the patient's care and are less endorsing of responsibilities postdischarge, say the researchers.

Despite this, a respective 70% and 77% of hospitals reported using "teach-back" techniques and giving all patients details about their medication at discharge.

However, medication reconciliation processes were nonstandardized at most hospitals. Three-quarters (75.3%) of hospitals reported that the discharging physician, physician assistant, or a nurse practitioner was always responsible for conducting medication reconciliation, while 6.8% reported that a pharmacist was responsible.

A total of 14.0% of hospitals suggested that this responsibility was not formally assigned to anyone at least some of the time, say Bradley et al, adding that the lack of standard processes in this area is "potentially problematic."

The team acknowledges that coordination of staff during patient discharge "might be extremely complex," but suggests that the diversity of efforts to reduce readmission rates that they observed warrants the establishment of more definitive evidence of effective hospital practices.

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