Can You Decrease Readmissions By 50%?

The June 10, 2014 issue of Hospitals & Health Networks (H&HN) contained the article Technology is the key to patient engagement at the individual level. It is worth reading.

It got me wondering about how we define engagement, wondering about engaging patients, and about engaged patients. I think engaged patients are the result of different efforts. Most efforts to engage patients stem from efforts made by the hospital.  They tend to be one-way, from the hospital to the patient. They reflect how the hospital feels its patients need to be engaged.  What they miss by not being two-way is a knowledge of how patients feel they need to be engaged with the hospital.

If the engagement were two-way both the patients and the hospitals would benefit.

I believe technology will be key to patient engagement. I think that designed correctly technology should play a major role in reducing readmissions. I also believe that someone should consider asking the patients how technology could help them.

I recently developed a patient access/experience strategy for the call center of a large teaching hospital. One finding was that 99% of all of the patients who asked to speak with a nurse received a voice mail stating that a nurse would get back to them within 48 hours. Because of my fear of large numbers I did not calculate the cost of those callers who went to ED, but it was orders of magnitude higher than the cost of having a nurse or two in the call center. Most of those who went to the ED did not have an emergency. Many simply wanted a refill.

Let’s look for a moment from thirty-thousand feet at how the discharge process works at most hospitals. When I am discharged I sign my discharge orders, and if I am lucky someone from the hospital calls me in a few days to ask how I am doing or feeling. If someone calls me on day three, and my wound opens on day four, or I am feeling sick, or there is a complication from my treatment or from my procedure or from my medication or from something new, what are my likely responses?

I could call the hospital—see above; I could ignore it; or I could go to ED.

If I was unsuccessful previously calling the hospital, I may not even consider that option. If I call, I might speak with someone who could help me, or I could get a busy signal, I could be put on hold, my call could be transferred, or I could be sent to voice mail—see above. Four of those responses are not good for me, and all five may not be good for the hospital.

Why? If I do not get to speak with someone, chances are that I will solve my problem by going to ED. If I do speak with someone they may tell me to go to ED or to the hospital. Chances are good that the hospital is going to incur a cost and record a visit that may
not have been necessary if the hospital had provided me with a technological

What might that technology look like?

I see it working something like this.

Before I am discharged the hospital adds me to their discharged patient portal, an interactive portal that contains information about the specifics of my illness or procedure—my meds, their side-effects, complications that could occur and what I should do about them, symptoms that may arise and what I should do about them. The portal also allows me to input data. I can input that I took my medications and any side-effects I am having. I can input any complications, my diet, exercise, BP and pulse, weight, and any
questions I may have.

The system would be designed to alert someone at the hospital each time any of the data I input is outside of the acceptable norms. This way, instead of me playing doctor and determining what I should do, the hospital can act before I act. They can have someone call me, can send a nurse to my home, or can send a physician to my home.

Not every patient will use this technology, but each one who does will not only be doing themselves and the hospital a favor, they will be more engaged and will have a better overall experience.


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