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Healthcare reform has been discussed for many years, at the federal, state and local levels. While its parameters have been unclear until recently, they are now coming into focus.
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When providers bring the family caregiver into the discharge process early, there is a better chance that the caregiver will be prepared to care for the patient at home, says Carol Levine, director of the Families and Health Care Project for the United Hospital Fund, a non-profit health services research organization based in New York City.
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When an analysis of readmissions indicated that a significant number of patients being readmitted within 30 days had been discharged to a post-acute provider, TMF Health Quality Institute, the Texas Medicare Quality Improvement Organization (QIO) established regular meetings with hospitals in the community, including Valley Baptist Medical Center in Brownsville, TX, and downstream providers including skilled nursing facilities, long-term acute care facilities, home health agencies, dialysis units, hospice providers, and rehab hospitals in the Brownsville area.
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Case managers are more likely to develop a discharge plan that works if they look beyond the reason for hospitalization and take into consideration everything that has been going on in the patient's life, says Jackie Birmingham, RN, MSN, MS, vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm.
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When Valley Baptist Medical Center in Brownsville, TX, began a project to reduce readmissions in the fall of 2009, the overall 30-day readmissions rate was 23.3%.
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A far-reaching redesign of the care coordination process at Norfolk, VA-based Sentara Healthcare has standardized the process across hospitals, centralized the administrative and clerical tasks that care coordinators must perform, and freed the staff at the bedside to concentrate on working with patients.
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Every case manager encounters challenging patients and family members those who are angry, provocative, depressed, or just plain ornery. That's because people in the hospital are sick, under stress, and often fearful about their situation.
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After Good Samaritan Hospital Medical Center in West Islip, NY, began a comprehensive process to reduce readmission rates for heart failure patients, readmission rates dropped from 21.1% to 15.3% in just a few months.
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Getting an entire staff of physicians, nurses, and techs to do things differently is never easy, but you can clear away hurdles by giving them the ability to formulate some of their own solutions. That, at least, has been the experience of Swedish Medical Center in Issaquah, WA, in its quest to implement a more efficient, no-wait ED concept. The approach appears to be sitting well with patients, too.
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A Hartford (CT) Physician Hospital Organization's program to reduce the rate of readmission for patients discharged with a primary diagnosis of heart failure has kept the readmission rate at between 11% and 13% for the last year, according to Linda Conroy, RN, BSN, clinical integration case manager for the Hartford Physician Hospital Organization, a partnership between Hartford Hospital and Hartford Physicians Association.
