10. Make Sure Patients Understand
Patients may nod, and say they understand what they're supposed to do after they leave the hospital. But "teach back," in which they and their caregivers repeat back those instructions, even to more than one hospital caregiver, needs to be constantly reinforced, readmission experts say. Jencks says that caregivers need to understand that their patients are often heavily medicated, stressed, groggy and confused. And that their disease state may impair their ability to understand what they are being told, much less remember it two days later.
11.Focus on Highest-risk Patients
Examine the readmission patterns at your hospital and see which patients, with which conditions, diseases or procedures, have the most readmissions. If resources are limited as they are at most hospitals, push them toward a select group of patients in a more intense way to see if increased effort makes a difference.
For example, in his New England Journal of Medicine Paper, Jencks showed that for certain diseases or conditions, and in certain parts of the country, readmission rates are even higher than the national average of one in five. For example, for medical patients, the readmission rate for heart failure patients was 27%; for those with psychoses, 24.6%; chronic obstructive pulmonary disease, 22.6%. Patients with pneumonia and gastrointestinal problems were re-hospitalized at 21% and 19.2% respectively.
For surgical patients, those with vascular surgery had the highest readmission rate, 23.9%, followed by those with hip or femur surgery, 17.9%.
States with the highest rates of readmission include Washington, D.C., 23.2%; Maryland, 22%; New Jersey, 21.9%; Louisiana, 21.9%; Illinois, 21.7%; West Virginia, 21.3%; Kentucky, 21.2%; New York, 20.7%; Massachusetts, 20.2%; Mississippi, 21.1%; Missouri, 20.8%; New York, 20.7% and Oklahoma, 20.1%. Perhaps these are the places where readmissions can be most quickly reduced.