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There’s No Silver Bullet: Reducing Avoidable Readmissions

Last week I had the opportunity to attend the Institute for Healthcare Improvement’s two-day training on “Reducing Avoidable Readmissions” training here in Seattle.

Reducing Avoidable ReadmissionsI’ve got some good news and some bad news. The bad news first according to this leading organization in healthcare quality improvement, there is no silver bullet. The good news is that there are a number of small practical steps to improve insight, quality, and patient experience.

This blog post provides an overview of the intensive 2-day training, and I’ll follow up with deep dives on a few sessions. Really, there’s enough content for a few weeks of blog posts, so we’ll use this forum to point out some best practices, and capture some of the best insights from the training. As with any training, so much of the value comes from the other participants, so we recommend checking out a training yourself in person. What was amazing about this course is that it brought together healthcare professionals who might not have had the opportunity to meet otherwise, and these different perspectives resulted in actionable takeaways for participants when returning home. Participants ranged from hospital CEOs and other C-level executives, to care coordinators across large and small health systems, primary care, hospitals and health systems, skilled nursing and in rural and urban settings.

Changing Healthcare ParadigmsRegardless of participant, it became clear that information did not flow well between these different healthcare settings, and that each specialty or care location had very little insight into what happened in the other setting. Just bringing these diverse participants together helped them see what could be done to improve patient handoffs and communication across the care continuum. A number of participants expressed how helpful it was to understand the process and constraints that others were seeing. Primary care physicians seemed to be the most handicapped as they had no way of knowing if their patients were admitted to hospital at all.

Sadly, for someone in the digital health field, another key theme that ran across the two days was how many participants felt that their medical records were preventing them from doing a better job on readmissions. The reason for this was two-fold: information did not flow between settings, and it was often too difficult to capture key information about the patient and access it at point of care. Medication reconciliation was cited as the holy grail of patient management but most participants didn’t believe it would ever be possible to get a clear solution to this problem.

Communication with patients was another key theme of the course, both in improving how patient discharge instructions and patient understanding of those instructions were delivered and in asking the patient for feedback. Again, it was a common sense approach rather than a “silver bullet.” Multiple presenters said “The reason your patient readmitted is in the hospital bed” or more simply, “ask the patient why they readmitted.”

Another key focus of the course was on change management within the organization. First understanding and then preventing readmissions requires change within the healthcare organization. Presenters had all led or participated in multi-year change journeys within their organizations and had both battle scars and key strategies for how to motivate and change within a large organization. One most basic tip was “don’t talk about readmissions, fines, or penalties” instead they suggested rallying teams around the benefits to the patients.

Topics that we’ll explore in more detail from the course here on the blog include:

  • Teach back and communicating with patients
  • Care transitions and discharge setting
  • Measuring change

Posted in: Behavior Change, Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare transformation

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