Hospitals Devise Strategies to Tackle 30-Day Readmissions (Part 3 of 4)

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RA-thumb5Continuing our look at the positive results experienced by healthcare organizations who are gradually confronting all-cause 30-day readmissions, we turn our attention to Holyoke Medical Center in Massachusetts.

Cheryl Clark writes in the May 2013 issue of HealthLeaders magazine that Holyoke “has an underserved patient mix that includes some of the most socioeconomically disadvantaged in Massachusetts.” Therefore, the task of reducing 30-day readmissions would seem insurmountable, especially when you consider that rates for January, February, and March 2011 were 13.5 percent, 14 percent, and 22 percent.

“But in the last three months of 2012, they had dropped to 12.7 percent, 9.2 percent, and 12.1 percent, with better health for patients with chronic obstructive pulmonary disease, one of the key targets,” Clark reports.

Holyoke’s strategy was simple, Cherelyn Roberts, RN, BSN, and program manager for the Holyoke STAAR inititiative (STate Action on Avoidable Rehospitalizations), said: “hit every single patient.”

“We interviewed some of our patients who were being frequently readmitted and discovered that many patients had never touched an inhaler,” Roberts said. “They were given a piece of paper and told to go to a pharmacy and get it, and then they were on their own. No one ever watched them effectively administer it.”

Education, therefore, became a key factor in making sure these patients didn’t return, and most importantly, that they knew how to use their inhalers.

But Holyoke discovered something else, Clark writes. They found “that the pulmonary program’s own policy prohibited people from attending pulmonary rehabilitation sessions if they refused to quit smoking.”  For an area with numerous smokers, this was a near-tragedy. Roberts said they “changed that immediately, offering patients nicotine replacement or smoking cessation support while they’re in the hospital.”

These sessions have tripled in attendance, going from “three to five patients a week to more than 20,” Jim Keefe, vice president of inpatient services, said, and Roberts added, “These patients are building up their physical endurance and activity, and I just looked at the stats. Hardly any of these patients is getting readmitted. It’s been a real win-win.”

Holyoke is also getting patients involved in reducing readmissions with “a scoring system for every admitted patient to rate his or her own likelihood of readmission, with five points indicating high risk and triggering much closer monitoring after discharge. Cognitive impairment, prior repeat hospitalization, and a repeated emergency department visit within the past three months score three points each, while having an end-stage condition scores a five.”

All of this information is given to Holyoke’s care team, from the smallest to the largest detail, so that “warm handoffs” can occur between team members, zeroing in on medication reconciliation, teach-back, etc. Keefe describes it as “an all-in situation.”

What are your thoughts on Holyoke’s approach? Do any of your initiatives emulate those outlined here?

Tomorrow, we’ll look at one more organization that is experiencing success with its all-cause readmission rates.

-by Pete Fernbaugh

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