Closing the gap on zero preventable readmissions

Doug Koekkoek, M.D.
Chief medical officer
Providence Health & Services, Oregon Region

April 17, 2013

Nowhere are the incentives better aligned to make real progress in hospital quality than in eliminating preventable readmissions.

Physicians don’t want their patients returning to the hospital because of complications or poorly coordinated follow-up. Hospitals face penalties for high readmission rates. Health insurers don’t want to pay for unnecessary care. And certainly patients want to stay healthy and avoid unnecessary trips back to the hospital.

Yet across the country eliminating preventable readmissions is proving to be a formidable challenge. With modern health care becoming increasingly complex, there are multiple opportunities for care to be less than perfectly coordinated.

Nationally, 30-day, all-cause readmission rates continue to hover in the 9- to 10-percent ranges for health systems similar to ours in Oregon.

We’ve moved our rates into the 7- to 8-percent range and are showing gradual progress. Still, our own case reviews find that close to 20 percent of our readmissions were preventable. So we can do better.

Improvement takes all of us – physicians, nurses, pharmacists and care managers. Research has found that no single intervention solves the readmission conundrum. It takes a bundle of interventions to reduce unnecessary readmissions:

  • Clinical stability at the time of discharge
  • Educating patients on their diagnosis, medications, and who and when to call if problems arise
  • Early follow-up appointments (three to five days after discharge), preferably made before the patient leaves the hospital
  • Home health and skilled nursing facility visits for the most fragile discharges

As we work to ensure that each of the above happens for every discharge, we all need to give that extra effort. Communicate with your bedside nurses and the follow-up primary care provider when making discharge decisions. Take the extra steps to ensure a follow-up appointment is made and that you have reviewed with your patients their care plan and what they can expect.

Getting to zero preventable readmissions will take commitment on everyone’s part. Join me in eliminating preventable readmissions.