Shift Happens: How to Dramatically Reduce Readmission Rates

Renee Letourneau’s recent article, “Realizing Readmissions Goals’ in offered interesting snapshots of the efforts of a handful of providers. The purpose of today’s post is to suggest a way to dramatically reduce the number of readmissions.

Two important criteria about achieving goals are; you have to set a goal to hit it, and the higher you aim, the more likely you are to hit something noteworthy. An example of a poor goal is ‘we do not want our readmissions to be any worse this year.’ What then is a noteworthy goal? Reduce readmissions by 2%, by 3%? What about reducing it by 20% or 30%?

Many of you may be questioning my sanity, or your own for reading this post thinking, “Don’t you think that if a twenty-percent reduction was possible that we would be doing that?

As you know, except for when I have been a patient, there is nothing clinical in my background. So I understand if your initial reaction to me writing about reducing readmission is chocked full of skepticism. Mine is too, but try to bear with me.

One area where there seems to be uniform agreement is that readmission rates haven’t moved much, and there is little indication of the rate declining noticeably any time soon. And that got me wondering; what if we change how we look at the problem? What if we shift our approach to solving it? Big problems require big ideas.

Once the patient leaves the hospital, other than a call from the hospital to the patient, the health system has zero access to additional information about the discharged patient’s health. Our only control over whether the patient will be readmitted is whether the patient complies with his discharge orders, and health systems have zero control over that.

Since we know that none of the efforts to reduce readmission rates has brought about monumental change, why not ask the question, “What would we have to do to reduce readmissions by twenty or thirty percent?” My guess is that having real-time, 24 x 7 information about the health of each discharged patient would be a big help.

What if instead of sending discharged patients home, we sent them to the floor of the hospital whose sole charge was to observe discharged patients? And on the floor we would observe and record information about each patient on the following; did/does the patient:

  • Take his medication as prescribed (I am not going to write ‘his or her’ medication for each bullet point because doing so would irritate me. If it makes you feel better to insert it parenthetically, have at it.)
  • Have a fever
  • Have any side-effects or complications
  • Manage his diet
  • Adhere to his discharge orders
  • Exercise
  • Schedule his follow-up appointment

As we observe and record the information, if something in a patient’s data raises an alarm, we are able to react to it. No new data, no reaction. one we have the information we can stop the problem from becoming worse. If we knew all of the information for each discharged patient for some fixed period of time, would we expect readmission rates to decrease? Of course we would.

We agree that knowing more about a discharged patient’s health after the individual is discharged would help reduce readmissions, perhaps even significantly. But it is unrealistic to create a ‘discharge floor’ for patients, so strike that idea. We could call each discharged patient every hour of the day but after about three calls both parties would hate that idea. So what is left?

Roemer’s Immutable Law: To reduce readmissions by 20%-30% we need 24 x 7 access to the discharged patient’s health information.

We do not have it.

We cannot get it.

What if there was a way for the provider to access the information it needs to enable the provider to manage the discharged patient’s health?

There is. The patient could provide it.

This solution should be designed to provide the same functionality and access as the discharge floor. The only way a solution will work is if the solution’s User Interface and User Experience are exceptionally good. I see it working something like this:

  • At discharge the patient is given a secure login to access the provider’s discharge portal—think of this portal as being the provider’s robust, online interactive Discharge App.
  • The Discharge App lets the discharged patient access the hospital using a computer or smart device 24 x 7
  • The Discharge App allows the patient to:
    • Enter the information the provider needs to manage the health of the patient
    • Access a variety of clinical and business processes
    • Access educational information about his illness or procedure
    • Access a clinician via email and online chat
  • The Discharge App allows the provider to:
    • Collect the data it needs
    • Assess the data
    • Determine if the data triggers an alarm
    • Determine if the patient needs to be called or needs a visit from a clinician
    • Reduce readmissions

This same idea would offer similar benefits in Population Health Management.

If you are interested is viewing a very rough mockup of what the Discharge App could look like, click on this link.

I would welcome your feedback, positive or negative.

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