According to Medicare, at least 20 percent of all patients who are admitted to a hospital will be readmitted within 30 days of being discharged. However, 75 percent of these readmissions could possibly be prevented with better care and education. Because driving down the high number of re-hospitalizations is not a simple task, hospitals, health systems, and health care professionals should all work together with the patients.
These are some of the reasons why there is a need to lower the number of re-hospitalization:
Patients who clearly understand their after-hospital care instructions, which includes how and when to take their medicines and when to return for their follow-up appointments are 30 percent less likely to be readmitted than patients who don’t have this information. Unfortunately, a huge number of hospitalized patients do not receive education on how to take care of themselves.
According to Jack BW et al. in Annals of Internal Medicine, Project RED (Re-Engineered Hospital Discharge Program) intervention provides the strongest evidence that supports the efficacy of enhancing hospital-based discharge processes.
In this program, a specially trained nurse conducts patient education while the patient is still in the hospital, arranges follow-up appointments, confirms medication routines, and prepares a patient-specific instruction booklet. Project RED also involves a pharmacist’s follow-up call to the patient 2-4 days after discharge to confirm the medication plan and to clarify any questions.
As a result of Project RED, 370 participants had 30 percent fewer readmissions and emergency visits than the 368 patients who did not participate in the intervention. The data shows that there is a significant connection between patient education and reduced hospital readmissions.
The term “key learner” does not only refer to the patient but could involve any individual who accompanies the patient during doctor’s appointments, assists the patient take his or her medications, takes care of the patient at home, and listens in to instructions at the time of the patient’s hospital discharge. In many cases, this role falls on the patient’s home health aide, which will be noted by the education providers to make sure that they will involve this individual in their teaching efforts.
The “teach back” strategy has been proven to very effective in determining the patient’s understanding of the concepts taught to them. In this approach, key learners are asked to communicate what they learned in their own words. Education providers could also guide them by asking questions related to the patient’s condition. For instance, the staff can ask the question “What is the name of the diuretic or water pill you take?” from a heart failure patient.
The “teach back” strategy could also be used by asking the patient different questions every day during his or her stay in the hospital. These questions can be knowledge-related (What steps are involved in following a low-sodium diet?), attitude-related (Why is it important to take your water pill daily?), and behavior-related (How will you remember to check for symptoms of heart failure every day?).
Educating patients entails additional man hours, which is why it’s important for the organization or the hospital to make patient education a priority. Besides, through multitasking and by maintaining clear documentation, discussions related to patient education would take less than 10 minutes per day.
Because patient education entails extra work for the hospital employees, it is necessary for strategies to be applied to make the adoption of the education system smooth. It is also important to make the scheme easy for the hospital employees to use in addition to their regular workload.
One example of such system is a software that prompts the hospital worker at a predetermined time to conduct the “teach back” strategy, including the questions that he or she can ask the patient.
The best education materials are designed to clarify concepts that patients may have trouble understanding. This means that, whenever possible, simple words and instructions should be used. Highlighting important information, such as a new medication should also be done to let patients know of the data’s significance.
Home health aides not only perform a vital role in the maintenance of the health and well-being of their patients, they are also important factors in protecting their patients from re-hospitalization. To do so, a home health aide should:
Communicate with the discharge planner. Before the patient leaves the hospital, the home health aide must speak with the hospital discharge planner and go over both parties’ expectations regarding the patient’s recovery, scheduling, and the provision of post-discharge care.
Organize the patient’s follow-up appointments. Inadequate follow-up and monitoring are some of the typical reasons for re-hospitalization. Unfortunately, fewer than half of patients see their doctor for a follow-up appointment between discharge and readmission. According to research, it is crucial for a patient to see a doctor within seven days of discharge to reduce the likelihood of his or her readmission to the hospital. In this instance, the patient or the home health aide and the hospital need to stay in close contact through phone calls for reminders to schedule and keep appointments.
Be familiar with the patient’s medication requirements. Based on research, adverse medication events account for over half of hospital readmissions among elderly patients. This means that patients need to receive a medication review upon admission, during the patient’s stay in the hospital, and upon discharge. There should also be medication education and counseling, as well as a regularly scheduled follow-up online or by phone.
Moreover, even before the home health aide returns home with the patient, it is important for him or her to understand everything about the patient’s medication routine. This is also the time for him or her to clarify questions about the prescriptions, especially if there are new ones.
Be mindful of the risk factors for re-hospitalization. There are factors that increase the risk of readmission in some patients. A diagnosis of heart failure or COPD (chronic obstructive pulmonary disease) are examples of such risk factors. Home health aides must learn all the possible risk factors so he or she will be appropriately prepared for any eventualities and deal with them in the appropriate manner.
Carefully monitor the patient’s condition. Home health aides are trained to note the changes in their patient’s behavior and determine whether these changes could lead to re-hospitalization due to an adverse event.
Keep the home free from hazards. An important part of a home health aide’s job description is to make sure that the patient’s home is free from anything that might pose a threat to his or her patient’s health and well-being. This is especially important to reduce the possibility of hospital readmission.
Aside from patient education, the other ways to prevent hospital readmission are the following:
Conduct real-time monitoring at home. The monitoring of a patient’s care and health status in real-time helps home health aides and other health care providers act swiftly to provide early intervention in the patient’s home. As a result, the need for hospital readmission is reduced.
Participate in a readmission prevention-focused initiative. These types of initiatives allow hospitals and other health care providers to work together and share strategies and best practices for preventing re-hospitalization.
Join incentive programs with payers. Health systems are working together with hospitals to give incentives to providers who successfully reduce preventable re-hospitalization. The guidelines of most incentive programs allow hospitals to realize savings if they were able to drive down the number of readmissions and lose money if readmissions increased.
Pay special attention to patients who are hearing-impaired or who have limited English proficiency. Patients who do not fully understand what is expected of them after their discharge are at greater risk of readmission. This is why it is important for hospitals to work with sign language experts and foreign language interpreters to properly communicate important information to the patients and vice and versa.
Hospital readmission is not only costly, it also puts a strain on the hospitals and could contribute to the patients’ overall frustration and dissatisfaction with their failing health and capabilities. Fortunately, these adverse effects can be avoided through patient education and other ways in which patients, health care professionals, hospitals, and other concerned organizations all work together toward achieving a common goal.
Sources:
Effective Interventions to Reduce Rehospitalizations: A Survey of the Published Evidence
www.academyhealth.org/files/SQII/STAARSurvey.pdf
Reducing Hospital Readmissions with Enhanced Patient Education
https://www.bu.edu/fammed/…/krames_dec_final.pdf
10 Proven Ways to Reduce Hospital Readmissions
http://www.beckershospitalreview.com/quality/10-proven-ways-to-reduce-hospital-readmissions.html
5 Ways Healthcare Providers Can Reduce Costly Hospital Readmissions
Can Caregivers Help Reduce Hospital Readmissions
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