U. of Michigan-nursing facility partnership cuts hospital stays, readmissions

A University of Michigan Health System (UMHS) sub-acute care program was able to cut average length of stay from 10.6 days to eight days, according to a study published the Journal of the American Medical Directors Association. In addition, hospital inpatient stays dropped by nearly 2,908 days a year, according to UMHS.

The program, now in its sixth year, pairs University of Michigan Health System geriatricians and nurse practitioners working in privately operated skilled nursing facilities to improve coordination, helping some of the most vulnerable patients--chronically ill, older adults in transition.

Called the "black hole" of fragmented care, according to study coauthor Tony Denton, University Hospitals executive director and U-M Hospitals and Health Centers chief operating officer, frail patients may not be well enough to discharge to their homes but are not sick enough to stay in the hospital and then move to a skilled nursing facility and disappear, he said in a statement yesterday.

Patients in transition are particularly vulnerable with reported readmissions and medication errors, among other potentially harmful events.

UMHS attributes the success of cutting down length of stay by two days to a close partnership between the university health system and the skilled nursing facility. Private nursing facilities coordinate placement for patients, seen as an extension of hospital care. This team of U-M physicians and nurse practitioners deployed at the skilled nursing facility follows patients after discharge and manages their care on-site.

"We are bridging communication gaps between the hospital and sub-acute providers, sharing a commitment to quality care," Denton said.

This team dynamic fosters better communication, according to the health system. For instance, conversations about patient care--often rushed at hospitals--slow down on the service to prevent misunderstandings, according to lead author and program director Darius K. Joshi.

The hospital and the facility also share electronic health records, including inpatient notes, consultant reports, medication lists and allergies.

"We aimed to break down the silos that are such a big problem in healthcare and improve the continuity of care. We found that an investment like this by a large health system does produce returns by improving the overall quality of coordinated care for patients discharged to care facilities," Joshi noted.

According to Medicare data updated this month, one in five Medicare patients bounce back to the hospital within 30 days of discharge.

For more information:
- see the announcement
- check out the study abstract
- see the editorial abstract

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