Case Study On Readmissions

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

In 2011, there were approximately 3.3 million readmissions to hospitals, raising healthcare costs and negatively impacting patient health. Two important contributors are discharge planning and education. Many patients do not receive enough of either, and are sent home misinformed about their diagnosis and medications. In order to decrease readmissions, hospitals should utilize interactive patient systems to educate patients while they are in the hospital. This will increase patient knowledge of their diagnosis, as well as make it easier for nurses to go over discharge teachings with the patient. This gives

With an audit by the Joint Commission (JC) in the near future, Nightingale Community Hospital (NCH) is performing a tracer patient survey to measure our compliance and identify issues that are in need of remediation. The practice of this type of survey tracks a patient’s care for the duration of their stay starting from the admission process and ending when they are discharged. This system allows us to assess our strengths and weaknesses concerning policy, procedures, and systems in place to provide quality care in conjunction with the standards set forth by the JC.

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

The long-term care services delivery system in the United States has changed substantially over the last 30 years . There are approximately 17,000 elderly and disabled persons are receiving care in nursing homes (NNHS, 2004). The number of people using nursing facilities, alternative residential care places, or home care services are projected to increase from 15 million in 2000 to 27 million in 2050 (HHS, 2003). Identifying the best nursing home that would fit their needs can be difficult and time-consuming. Although nursing homes usually provide certain basic care that patients need, some nursing home facilities provides special care for certain types of individuals with special needs. For example, people with dementia, AIDS, ventilator-dependents,

The main theme identified in this research focused on the Hospital readmission rate that has gained increasing attention because it reflects the effectiveness of healthcare system performance and the quality of patient care. The five articles studied all highlighted that an effective discharge planning is crucial to improve continuity of care between hospital and home/elderly home so as to improve patient’s health and reduce patient readmission. The themes that emerged described discharge planning in the hospital as pivotal in the continuing care of people who are in need of medical, social and rehabilitation care. Additionally as the needs of patients increase and become more complex, it is also important that an effective discharge planning system should have the capacity to discriminate and respond to different levels of need for coordination and post-discharge care (Central, 2012).

In 2013 readmission following hospital stays for AMI, CHF, COPD or pneumonia the cost for readmissions totaled $7.0 billion, which accounted for 13 percent of the cost for total readmissions in the nation (Fingar & Washington, 2015). The highest readmissions fell with HF, followed by COPD, pneumonia then AMI. Trends from 2009-2013 showed a decrease in the overall hospital Medicare readmissions by an average of 9 percent and this was from these top four diagnosis (Fingar & Washington, 2015). This information came from Healthcare Cost and Utilization Project (H-CUP) which is a group of healthcare data bases. Through technological use of several software tools the data needed for this project was abstracted. This is a perfect example of using technology to improve the processes for healthcare improvement by supplying needed data for analyzing to gain the knowledge for change within the healthcare systems (Fingar & Washington, 2015).

The original residential treatment model consisted of a 3 to 6 week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as Alcoholics Anonymous.

Your hospital will be penalized if you get readmitted within 30 days because of the chronic disease mismanagement. The Affordable care act (ACA) has changed the perspective of chronic disease management of hospitals, shifting their focus from treating the conditions to deciding ways to prevent them. Under ACA, hospitals will be penalized or rewarded depending upon their performance on 30-day readmissions, infection control and patient satisfaction levels (1). Government is playing his role to reduce the burden of chronic diseases in society but being a responsible citizen, do we realize the intensity of situation and the economic instability it is causing?

Recently the hospital had a meeting about the way the facility would be reimbursed due to hospitalizations that occurred within a thirty day readmission connected to the same diagnosis. The educators were forced to evaluate how staff could improve in eliminating infrequently readmissions. The lack of information given and understood by the patient guarantees a readmission due to the nurse not fully understanding that for patients with CHF to avoid readmission due to noncompliance nurses and health care staff must ensure that the

Each year the number of readmissions of the heart failure patient within 30 days of discharge has grown. The Medicare division in relation with the Affordable Care Act is reducing the amount of money they are willing to pay for readmissions to the hospital. Hospitals are now more than ever looking for ways to reduce the number of readmissions to the hospital for the heart failure patient. The purpose of this paper is take a look at a program designed with to reduce the readmission rates of one hospital to reduce the number of readmission through improved education and follow up of the heart failure patient.

Much of the research is not specific to the rural setting in the United States, but all inclusive of populations in all areas, urban, suburban and rural. So how do we, as Care Managers meet the needs of the rural population, improve overall health and reduce hospital readmissions?

Although nursing homes are here to stay, frequent illness and hospitalization that exist because of a lack of primary prevention in them require unnecessary healthcare costs (Graverholt, Forsetlund, & Jamtvedt, 2014). This problem stems from a downward spiral: As the seven dimensions of health lower from a societal neglect of primary care, susceptibility to illness becomes higher, and the toll illness takes on the patient drives his or her health even further downward. For example, Jim, my uncle, was paralyzed, transferred to a nursing home, and then hospitalized within a week for pneumonia. Immediately after, he was diagnosed with MRSA, transferred to a different nursing home, diagnosed with depression, and hospitalized within three months for a kidney infection. Now he is still in the hospital awaiting another stressful transfer. In the long run, this preventable hassle actually drives up U.S. health care costs by spiking future chronic disease. Patient quality of life also suffers. (U.S. National Diabetes Education Program, n.d.)(Ornish, 2010). Thankfully, etiological risk factors of health deterioration, also defined as causative factors of preventable patient quality of life decline, have been investigated for nursing home residents. Unsurprisingly, the main

The information contained in this report was gathered in a private nursing home over 2 weeks that for the sake of this essay, be called “facility x”

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.