A Hidden Cause of Readmissions Comes to Light

Cheryl Clark, for HealthLeaders Media , February 13, 2014

Rarely Tracked
What's more, the precise reasons why those patients are being readmitted are rarely tracked and quantified, at least not with the intensity that national efforts to prevent readmissions in patients with medical conditions such as heart failure, pneumonia, and heart attack have been to date.

Public reporting that would shed light on these complications is largely absent. Medicare's Hospital Compare mainly shows rates of complications from surgery that occurred before the patient was discharged, not after, Hawn says.

Her study looked at 59,273 major surgical procedures—such as orthopedic, vascular, or gastrointestinal—performed at 112 VA hospitals from January, 2005 to August 2009. It found that 22.6% of these surgical patients developed a serious complication, and nearly one-third of those, or 28.1%, occurred after discharge.

Almost 12% of patients developed complications so severe, they could not be treated in an outpatient setting and had to return to the hospital for an inpatient stay.

Complications included:

  • Surgical site infections that weren't apparent at the time of discharge respiratory complications that required a ventilator or resulted in pneumonia, stroke or coma
  • Venous thromboembolism
  • Urinary tract infections
  • Renal failure or kidney infection

Most surgical readmissions the research discovered were due to infections, discovered when patients develop a fever or redness of the surgical wound a week or two after hospital discharge, Hawn says.

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3 comments on "A Hidden Cause of Readmissions Comes to Light"

Kate Toomey (2/20/2014 at 2:02 AM)
An element missing is the key role a SNF can play as a partner in reducing rehospitalizations by ensuring at risk patients receive appropriate care until they are safely ready to go home. Our Central Massachusetts facility ended our last quarter with an 8.3% rehospitalization rate compared to Central Mass average of over 21% and the State over 23%.

Kathleen Dowis (2/19/2014 at 3:43 PM)
CMS is targeting hospitals in areas that they have little or no control, for readmission penalties in an effort to further decrease reimbursement. You can provide all the resources available, but you should not have to be responsible for how a patient chooses to adhere to recommendations/teachings once they leave our care. Unless they are proposing that hospitals start making house calls for the first 30 days after discharge. We are constantly being set up for failure by the regulatory agencies.

G. J. Johnson DHA MSN RN (2/15/2014 at 9:24 AM)
This article highlights what nurses have said for years. Patients cannot be shoved out the door so quickly that a proper assessment, patient and family teaching, arrangements for community services, and modifications to the living environment are lacking. The follow up after discharge falls through the cracks and patients are merely instructed to see their Primary Care Physician or surgeon. No one sees the patient until the patient takes the initiative, and the patient is quite obviously a poor judge of when to seek timely intervention. We need more community-based follow up. Hospitals should invest in nursing services to follow the patient and maintain contact until the person is totally convalesced or placed in a facility. In other words, we need to increase the number of RN case/care managers and home health nurses if readmissions are to be reduced.




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