Score patients' readmissions risk to cut length of stay, costs

With Medicare penalties for excess readmissions for heart attack, heart failure and pneumonia in effect, hospitals might want to implement a scoring system that identifies low-risk ST-elevation myocardial infarction (STEMI) patients, according to new research from the Minneapolis Heart Institute Foundation.

The study found the "simple-to-calculate" risk scores reveal opportunities for hospitals to discharge patients early, reducing length of stay and total hospital costs, all without jeopardizing patient safety.

"These risk factors can be easily and quickly assessed by the healthcare professionals within a hospital," senior author Timothy D. Henry, an interventional cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital, said Tuesday in a statement.

The study retroactively applied the scoring system to STEMI patients between January 2009 and December 2011. Patients identified as high-risk were older and had more hypertension, diabetes and previous coronary artery disease, among other factors. The low-risk patients had statistically significant lower mortality and complication rates than high-risk patients.

Using a risk scoring system, hospitals can safely discharge low-risk STEMI patients a full day ahead of their high-risk counterparts, saving nearly $7,000 in total hospital costs, the study noted.

With thousands of dollars saved and safety intact, the Minneapolis Heart Institute is incorporating the risk scoring system into its quality improvement program, aiming to better help low-risk patients avoid the cardiac critical care unit and be discharged within 48 hours, Henry noted.

To target efforts that reduce readmissions and costs, hospitals need the technology to identify patients, assess risk, provide interventions and monitor effectiveness in "real time," former hospital CEO Kevin L. Shrake suggested in a Hospital Impact blog post yesterday. Therefore, readmission reduction best practices must include "advanced analytics that calculate the likelihood of readmission allowing for early intervention in the high risk population," he said.

To learn more:
- read the statement (.pdf)
- check out the study abstract
- here's the blog post