Leading the effort to keep readmissions low are Kevin R. Wheelan, MD, chief of staff, and Nancy Vish, RN, president and chief nursing officer at Baylor Heart and Vascular. When the center opened in 2002, leaders knew they wanted to design an approach to discharging patients that would keep their readmissions very low. To address this, they established several subcommittees involving both clinical and administration staff to design standards that would work well for the entire team.
“We didn’t want to set our standard at 80% or 90%; we set our standard at 100% [zero preventable readmissions] from the beginning because we knew there couldn’t be a compromise on it,” explains Vish. “We use a shared governance approach, so we established multidisciplinary teams for the clinical practice and education components. It was unique because our leaders and our staff were all sitting at the table together, and all bringing different strengths to creating the process. ”
With clinicians, physicians, and hospital leaders engaged in the process together, Baylor was able to do rapid cycle improvements—rather than taking a month to enact a change to its standards, it could make improvements in days. That enabled the hospital to concentrate on the variance in its metrics and look at the sustainability of a change or introduce another intervention when needed.
The new process for discharge began at the moment of admission, Vish explains. Upon admission, a nurse reviews all of the patient’s home medications. Then, the physician reviews the information to determine how the medication will continue during hospitalization. During the preparation for discharge, the physician may order new or modified medications and will then review with the patient. To help ensure that the patient understands his or her medication and any other physician orders, the nurse will review the same information with the patient prior to discharge.