By Charu Raheja and Ravi Raheja
Hospital readmissions in which a patient is readmitted to a hospital within thirty days of their previous stay are costly for both patients and hospitals, as well as a potential detriment to patient health. Yet, roughly one in five Medicaid patients find themselves returning to the hospital within thirty days of their most recent hospital treatment. Michael Hodin, in his October 19, 2015 article in The Fiscal Times, titled “This Hot New Technology Can Save Medicare” says, “Readmissions [alone] totaled 42 billion in spending in 2014.”
Why Hospital Readmissions Occur: A common cause for readmissions is poor follow-up by the patients after the procedure. Frequently, following a discharge, patients go home confused about their medication orders, don’t follow the treatment plan, or neglect to follow-up with a doctor visit in a reasonable time frame. Family members might be able to help patients follow discharge instructions, but they are often distracted because of the hospitalization or might not be able to help with the patient discharge plan once the patient goes home.
A Plan for Decreasing Patient Readmission Occurrences: Decrease patient readmissions by following this two-part process:
1) Review discharge instructions with the patient in their home: A trained medical professional who can go over the discharge instructions with the patient once he or she returns home helps decrease patient confusion and increase compliance with discharge instructions. This should ideally be done within two days of the patient’s release and then again within ten days, depending on the severity of the patient’s condition during the hospital visit. The medical professional reviewing the discharge instructions should also be prepared to answer additional medical questions the patient might have during the call.
Patients often ask medical questions when receiving the post-discharge phone call. The medical professional needs to be trained in triage and prepared to determine if the symptoms presented are expected for the procedure or are unrelated to the procedure and if they require special attention.
2) Provide access to a trained medical professional 24/7: Studies show that patients who have access to a registered nurse are more likely to follow instructions, are better able to decipher the appropriate level of care for their symptoms, and are more inclined to avoid the ER. Having nurses available to patients gives them the confidence to stay home and allows them to call and ask questions any time a symptom arises.
Nurses need to be available 24/7 (including holidays) to answer patient questions after the hospital visit. Hospitals can opt to train their own nurses to make outbound calls using standardized protocols for patient questions and have their own triage nurse available for patient call requests.
An alternative for hospitals is to use an outsourced nurse triage service. These same triage nurses make the outbound calls following patient discharge.
Ensuring Continuity of Care and Physician Follow-Up: The discharge physician should provide customized follow-up instructions to the nurse handling follow-up calls. Nurses can then perform outbound calls to patients after a hospital visit, walk the patient through care instructions, answer questions, and evaluate any symptoms.
In addition providers need to receive reports from the triage nurse following every patient interaction to allow for continuity of care.
Studies have shown patients who receive proper follow-up after discharge are less likely to be readmitted to the hospital and are more confident and satisfied with the care provided to them (“Follow-up With Patients After Discharge” by Zack Budryk). Telephone nurse triage used for patient discharge follow-up drastically reduces patient confusion, hospital readmissions, and overall cost of care while also guaranteeing full continuity and high patient satisfaction.
Founded in 2005, Triagelogic is a URAC accredited, physician-lead provider of quality telephone nurse triage services, triage education, and software for telephone medicine. The TriageLogic group serves 7,000 physicians and covers 18 million lives nationwide. For more information visit www.triagelogic.com.