Curbing readmissions doesn't have to be costly

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It was almost too good to be true, but the results showed that it really worked. When Chicago's Mount Sinai Hospital embarked on reducing readmissions with the Project Re-Engineered Discharge model, otherwise known as Project RED, program leaders couldn't believe it lowered readmissions from 34 (from July 2010 to January 2011) to only 5 (from February 2011 to July 2011). Even better, it didn't require new staff or additional dollars, Leslie Zun, chair and professor of the emergency department, said at Friday's World Congress 3rd Annual Leadership Summit on Hospital Readmissions in Falls Church, Va.

Before implementation, readmission rates for heart failure stood at an average of 4.85 per month. After implementation, that figure plummeted to less than one average readmission per month (an average of 0.83).

Cutting down on readmissions though doesn't have to be costly, Zun explained at the conference. With challenging reimbursements, Mount Sinai Hospital is a resource-limited institution, serving populations with high rates of cardiovascular disease and obesity, low high school graduation rates and high unemployment.

Using existing staff through the Project RED model, Mount Sinai dramatically cut down on readmissions by mapping out a care plan for inpatient, outpatient and emergency care.

How does it work? All team members have clear roles and responsibilities. A discharge coordinator, or "discharge advocate," coordinates all the discharge activities with the patient, including planning with the primary care physician, therapists, nutritionists and social workers; educates the patient and family members about medication and treatments; reviews the care plan with them; schedules post-discharge appointments; as well as collects discharge-focused data.

The patient's physician initiates the care plan, participates or leads the discharge planning rounds and communicates the potential date of discharge. The nursing staff helps to educate the patient and family, communicates with each other and other providers and participates in multidisciplinary rounds. The pharmacist verifies physician orders, reconciles medications and contacts the patient after discharge. The emergency department uses a congestive heart failure order set and encourages patient discussions with the primary care provider.

All team members know the discharge process starts at admission and help to educate the patient throughout hospitalization. Patients receive discharge information in their own language and at their reading/literacy levels. And finally, caregivers help to reinforce that plan after the patient leaves the hospital. The patient receives follow-up calls from the pharmacist to see if the patient has any medication questions and from the discharge coordinator about the care plan. The primary care physician also receives a discharge synopsis and the after-hospital care plan.

Even though program implementation at Mount Sinai didn't require any more staff members or financial expenses, the project did have time costs, Zun told FierceHealthcare. "It was labor intensive for the core group," he said. However, they limited weekly meetings to core members of the program stakeholders to avoid time drains.

Even with the associated time costs though, it might be hard to argue against those dramatic outcomes.

For more information:
- visit the Project RED website

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