A Hidden Cause of Readmissions Comes to Light

Cheryl Clark, for HealthLeaders Media , February 13, 2014

Since four years have passed since data collection ended, might hospitals have begun to launch more aggressive efforts to prevent post-discharge surgical complications? Hawn says she doesn't think so.

"Hospitals now have 95%, 96%, and 97% adherence to these process measures, or even higher. And yet surgical patients are still getting VTEs and infections, and still being readmitted," she says.

A Tough Task
Hawn says it's crucial for hospitals to be more diligent about preventing these surgical complications. But that's a labor-intensive task. Patients who develop these complications may not be readmitted to the same hospital where they had the surgery. Hospitals usually learn how many of their patients get readmitted, but Hawn says most hospitals do not have a system to track the reasons why. Was it due to a fall, or something related to the surgery? There's often no way a hospital can know without a huge amount of effort they don't have the resources to make.

Another problem with the system, she says, are the surgical care improvement project or SCIP process measures that are now included in Medicare's value-based purchasing program. These prompt hospitals to perform blood cultures and administer antibiotics to patients undergoing surgery to prevent infections or blood clots.

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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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