A two-year initiative spearheaded by a 15-member clinical excellence committee has put Oaklawn Hospital at the forefront of reducing unplanned patient returns.
“Since 2009, we’ve reduced the number of our readmissions by 24 percent,” said Jane Jones, the hospital’s executive director of organizational excellence. “This is the result of much hard work by Oaklawn’s team, and it’s wonderful to see a new level of patient safety grow from that work.”
Many approaches have been implemented to achieve that outcome, frequently focusing on patient education, Jones said.
The discussion of hospital readmissions nationwide has grown in recent years because of efforts by the U.S. government to address high hospital-return rates. Surveys have indicated that nearly 1 in 5 Medicare patients have returned to hospitals with a month of discharge, a fact that contributes to higher health-care costs across the country. For that reason, Medicare has been preparing to penalize hospitals with frequent, potentially avoidable readmissions.
The effort to reduce Oaklawn’s rehospitalization rates for all medical and surgical patients began in 2010, Jones said.
“At that time, our baseline data showed we had a rehospitalization rate of 6.62 percent,” based on figures collected internally about readmissions for any cause, she said. “Our goal was to reduce our rehospitalizations by 30 percent within four years, with the goal being 4.62 percent.”
After the new approaches were implemented, Oaklawn’s rehospitalization rate during the period of January through June 2012 was 5 percent, she said. The data were drawn from records that include unplanned rehospitalizations linked to any conditions arising within 30 days of the original hospitalization.
An Oaklawn-based committee studied several models for improvement, issued recommendations and oversaw their implementation, Jones said. The new approaches include ways patients might better learn to monitor their medications and self-care.
For example, a discharged patient now receives a special bag to hold all new home medications and new prescriptions, with instructions to take them to the patient’s physician for a discussion about their proper use, Jones said.
Other methods included more frequent consultation with pharmacists and other care providers, and more frequent contact with patients and their families after discharge from the hospital.
“Our work is ongoing, with the intent to bring that figure down further in order to meet our 30 percent goal,” Jones said. “After all, once a patient has left the hospital, the last thing he or she wants is to come right back, to treat the same problem – or something new.”
The collected data are based on measures developed in conjunction with the Center for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, Jones said. Complete results for all participating U.S. hospitals can be accessed at www.hospitalcompare.hhs.gov.
That website also includes data pertaining to the Hospital Consumer Assessment of Healthcare Providers and Systems survey of 3,858 U.S. hospitals, which in July ranked Oaklawn among the top 7 percent in the United States for patient satisfaction. Oaklawn's performance for the most recent public reporting period also is posted under the “satisfaction” heading at qss.oaklawnhospital.org.
Oaklawn’s committee reviewed the medical literature related to rehospitalizations and based many new intervention procedures on national and state initiatives. These included:
-- Project BOOST – also known as “Better Outcomes for Older adults through Safe Transitions” – sponsored by the Society of Hospital Medicine.
-- Project RED – “Re-Engineered Discharge” – sponsored by the Agency of Healthcare Research and Quality.
-- MI STA*AR – Michigan State Action on Avoidable Rehospitalizations – sponsored by the Michigan Health and Hospital Association’s Keystone Center for Patient Safety & Quality.
In addition to Jones, Oaklawn staff members serving on the Rehospitalization Committee are Sara Andrews, Chris Condon, Stephanie Elmendorf, Janet Forgacs, Traci Fowler, Audrey Hoffman, Deb Lyons, Mark Paulus, Sherri Seifert, Mary Shoup, Carol Waite, Kathy Walsh, Kim Weaver and Donna Young.
“At Oaklawn, we continue to put the greatest emphasis on the sort of teamwork that will produce the best possible patient care and satisfaction,” Jones said. “We’re so pleased to see these efforts reflected in these readmission results.”
“And, naturally, while we’re delighted to be able to report such results, we’ll continue in every way possible to build on them,” she said.