Readmission rates have increasingly become a measure of a hospital’s quality of care. As part of the Affordable Care Act, Medicare is planning to tie payment to readmission statistics, even penalizing hospitals for readmissions deemed avoidable.
With that punishment looming, hospitals and health policy experts are trying to figure out why so many patients are making round trips.
Are patients simply being let go too soon? While some patients may be let go before they are “completely and totally recovered,” says Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), the issue is far more complex than that. Sometimes, infections develop. In other cases, there is unexplained bleeding. Medication errors are a big factor, too. Often a patient isn’t able to get an appointment with a primary-care doctor or the patient simply feels that something isn’t right and doesn’t know where else to turn.
Researchers looking at this trend are discovering that breakdowns occur on multiple levels. The most critical failure seems to be in the discharge process, when the hospital should be preparing a patient for release. Instead, says Brian Jack, a family physician at Boston University Medical Center, the process is often a “perfect storm” of errors that begin even before a departing patient has reached the parking lot.
Many patients leave the hospital without understanding much about their diagnosis or how to handle their condition at home, including what medications to take, says Clancy.
Poor coordination of care and poor transitions in a fragmented system is how Jesse Pines, director of the Center for Health Care Quality at the George Washington University School of Public Health and Health Services describes it.
Proper post-hospital care involves many complicated steps. There are medication routines, follow-up sessions with doctors or physical therapists, adjustments to diet and lifestyle, even knowing what number to call if there’s a problem or a question. It can be very difficult to manage all this, especially if a patient has no caregiver at home or is in a weakened state upon release.
Many hospitals put instructions in writing, handing departing patients a “discharge summary” of steps they need to follow at home. But that summary can be difficult to read or understand; often it is handwritten and filled with jargon. And putting a discharge summary together is not always a doctor’s highest priority. The task often falls to others — nurses or medical residents — who rarely have the time to make sure the patients understand the plan for follow-up care.