Each year, hospital readmissions cost healthcare systems billions of dollars. While not all of these outcomes can be avoided, it’s estimated that nearly 25% of all hospital readmissions are preventable. In this article, you’ll read about causes, statistics, how readmissions affect healthcare, and three actionable tips to help prevent them.
Table of Contents
- What Qualifies as a Hospital Readmission?
- Causes of Hospital Readmissions
- Hospital Readmission Statistics
- How Hospital Readmissions Affect Healthcare Facilities
- 3 Ways to Prevent Hospital Readmissions
- Conclusion
What Qualifies as a Hospital Readmission?
According to the Center for Medicare & Medicaid Services (CMS), hospital readmission is “an unplanned hospital admission within 30 days of the initial visit to the same hospital or a different hospital for reasons related or unrelated to the original cause of stay.”
Causes of Hospital Readmissions
1. Failure to Attend Follow-Up Doctor’s Appointments/Adhere to Treatment
A study done on patient readmissions found that the average follow-up appointment was within 14 days of hospital discharge. The same study concluded that on average, hospital readmission occurred within 12 days of discharge, showing healthcare that sooner follow-up appointments may be necessary.
Additionally, the failure to adhere to discharge treatment and care results in a large portion of hospital readmissions per year. This includes clear instructions and information on taking prescribed medications and attending appointments.
2. Inadequate access to prescriptions following discharge
One study found that one of the major factors of patients returning to the emergency room following discharge was a failure to get prescribed medications filled. This figure was especially higher for males of low socioeconomic status. This shows the need for potentially increased resources, including transportation, access to affordable prescriptions, and clear discharge plans.
3. Conditions with High Rate of Readmission
Certain conditions come with complications that lead to a greater risk of rehospitalization. The Agency for Healthcare Research and Quality (AHRQ) released survey listing conditions that put patients at a higher likelihood of being readmitted. Statistics include Medicare, Medicaid, uninsured, and privately-insured patients.
- Congestive heart failure
- Sepsis
- Pneumonia
- Chronic obstructive pulmonary disease (COPD) and bronchiectasis
- Cardiac arrhythmia (Abnormal heartbeat)
- Mood and Psychotic Disorders
- Diabetes
- Renal Failure
- Complications related to pregnancy
- Alcohol & substance abuse-related disorders
- Osteoarthritis
- Cancer
4. Demographics
Studies have determined that certain demographics are more likely to be readmitted to the hospital following their discharge. Surveys show this is related to a lack of transportation and inadequate finances to afford medicine. Certain demographics include, but are not limited to:
- Elderly (65+)
- Men
- Lower Socioeconomic Status (SES)
- Medicare/Medicaid/Uninsured vs. Privately Insured
Hospital Readmission Statistics
[Source(s): AHRQ, 2018; KHN, 2021]
- There were 3.8 million hospital readmissions in the US in 2018
- An average of 14% of hospital patients were readmitted within 30 days in 2018
- On average, each hospital readmission cost the payer upwards of $15.2k
- Sepsis accounts for around 8.2% of readmissions, followed by heart failure (6%)
- 9 out of 10 (90%) acute-care hospitals have been penalized for readmission rates in the last decade (2021).
- One study showed that 76.5% of readmissions were related to patients experiencing abnormal or worsened symptoms.
- 1.3% of that study stated they felt they were discharged too early.
- 3.2% of that study stated they had complications from the original admission
- 1.8% did not have adequate at-home or outpatient treatment
- 2% went back to the hospital for non-medical reasons, such as lack of answers provided by staff the first time around.
How Hospital Readmissions Affect Healthcare Facilities
On October 1st, 2012, The Department of Health and Human Services implemented the Hospital Readmissions Reduction Program (HRRP) to encourage hospitals to take the necessary steps to improve processes and communication to reduce hospital readmissions.
This program was in response to statutory requirements updated by the Social Security Act [Section 1886(q)]. Under these requirements and regulations, hospitals may be penalized for hospital readmissions within 30 days for the following conditions:
- Acute Myocardial Infarction (AMI)
- Chronic Obstructive Pulmonary Disease (COPD)
- Heart Failure (HF)
- Pneumonia
- Coronary Artery Bypass Graft (CABG) Surgery
- Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA)
Penalties involve payment reduction to hospitals from government programs like Medicare and Medicaid. A 30-day review period is given to qualifying hospitals that wish to submit a claim based on the data provided by the HRRP.
In addition to losing out on payments, hospitals struggle with providing adequate staffing to the increase in hospital readmissions, especially with staffing shortages. A study done on the effects of the implementation of HRRP show that hospital readmissions have decreased since 2012. However, continued efforts are necessary.
Another study by The Government Accountability Office (GAO) showed that hospital staff and nursing shortages may contribute directly to increased hospital readmission costs. This is especially prominent throughout the pandemic and as we move into the next phase of COVID-19 and its effects on healthcare. With less staff able to care for increased numbers of patients, burnout is more rampant than ever, causing increased costs associated with premature discharge, medical errors, and decreased patient satisfaction.
3 Ways to Prevent Hospital Readmissions
1. Monitor Abnormal Vital Signs (AVS)
Monitoring patients’ vital signs within 24 to 48 hours prior to discharge has been shown to be a predictor of avoiding premature discharge, therefore reducing readmission.
- A study on “Vital Signs on Hospital Discharge and Readmission Rates” shows that abnormal vital signs within 24 hours of discharge are related to readmission within 7 days.
- A study on “Association of Vital Signs and Process Outcomes in Emergency Department Patients” shows that artificial intelligence (AI) models may be helpful in reducing patient readmission within 72 hours of discharge in patients with abnormal vital signs.
By staying up-to-date on patients’ vital signs through hourly rounding, medical staff, doctors, and nurses can ensure that the patient’s needs are being monitored and communicated amongst those who need to know. In return, this prevents hospital readmissions by taking preventative measures instead of reactive measures associated with the stressors & costs of readmission.
Using a healthcare digital rounding tool like Seyzo Health can help your healthcare organization and hospital monitor AVS through notifications on the platform- so you can stay in the loop and feel confident with a patient’s discharge plan.
The 4 Vital Signs to Look Out For
- Body Temperature
- Pulse Rate
- Breathing Rate (Respiration)
- Blood Pressure
2. Identify Patients at High Risk of Readmission
Research has shown that models related to identifying patients at high risk of readmission at discharge are more likely to be readmitted than patients identified at their arrival time. An “at-admission” approach is an effective way of identifying and planning for potential risks.
Nurses and medical staff can review patients’ risk of readmission by examining their incoming condition, vital signs, medical history, socioeconomic status, cultural factors, and medication history. By holistically understanding the patient, staff can be better prepared to avoid adverse outcomes through preventative measures.
3. Improve Communication
Hospital discharge planning involves coordinating the patient, staff, leadership, and friends & family. It’s believed that potentially 25% of hospital readmissions can be avoided with improved communication between healthcare teams and their patients.
Something as small as forgetting to log a patient interaction or make note of an AVS can lead to a snowball effect of poor outcomes in healthcare. By improving communication within your team and ensuring that no concern is left unsaid, you guarantee that staff can work together like a well-oiled machine.
When interacting with patients, following a script for hourly rounding and asking both specific and open-ended questions can open up a dialogue surrounding any grey areas or misunderstandings. This ensures that at the end of the patient’s care, they can safely be discharged with clear goals for aftercare and what they need to follow up with.
Using a healthcare digital rounding tool such as Seyzo Health allows for seamless closed-loop communication between teams, so you can ensure that all of the necessary information is logged and available to the correct staff. Our customizable templates allow you to ask the questions you need to and fit both your organization and patients’ needs.
Conclusion
Each year, hospital readmissions cause healthcare organizations to deal with penalties, decreased payment, employee burnout, and lowered patient satisfaction. By taking actionable steps to ensure safe discharge planning, you can take the next step in preventing unfavorable outcomes for your patients.
Nurses and other medical staff can follow these three steps to prevent readmissions for a safer hospital environment: monitor abnormal vital signs, identify patients at high risk of readmission and improve communication.
Interested in learning more about Seyzo Health, the digital rounding tool that can assist you in staying on track and improving communication? Request a demo or reach out for more information. We’re ready to help you decrease hospital readmissions.
