30 Day Readmissions – a 4 Year Look Back of Multi-Disciplinary Efforts

Purpose:  Hospital readmissions have been identified as an indicator of poor quality care, are costly and largely preventable.   As the focus of hospital readmissions became more evident with the Affordable Care Act, our program began discussions on how to reduce our 30 day readmission rate.   Since BMT programs are structured, process driven, and well communicated, we felt this combination was ideal for identification of weaknesses and areas for improvement to reduce our rate. 

Implementations:  Our first action was a real time multi-disciplinary review of every 30 day readmission.  The hope was to identify contributing factors with input from all team members that may not have been captured through documentation alone.   Unfortunately no common themes were identified.  Other early on initiatives included:

·         A hospital wide initiative was instituted for Nurse on Call to contact all patients by phone within 48 hours of discharge. 

·         We began utilizing our BMT PharmDs for allogeneic discharge medication education.  Unit nurses and nurse coordinators still perform medication education; adding the third clinician to create the individualized medication schedule was a hope for increasing medication compliance.

·         Our nurses began assessing autologous patients in person within 48-72 hours of discharge instead of immediate return to their local oncologist.   

·         All patients must be seen by a BMT physician within 5 days of discharge and have the appointment scheduled prior to leaving the hospital. 

·         A longstanding effort is the post-transplant preparation group held monthly prior to discharge.  Multi-disciplinary team members gather to educate patients and families on what to expect after discharge. 

A revived effort in reducing readmission was warranted as the pressure to decrease our rate continued.  The most recent initiatives this year include:

·         The creation of a same day BMT Acute Care Clinic.  If patients call with complaints, there are dedicated appointments  where BMT physicians assess and treat patients the same day.

·         Midlevel providers and transplant nurse coordinators began a twice a week huddle to discuss upcoming discharges and identify potential hurdles to discharge. 

·         Mid-level providers began collecting a readmission survey in attempt to gather more data surrounding the readmission reason from a family member/caregiver perspective.

Conclusion:  While our 30 day readmission rate has decreased from 34.6 in 2009 to current rate of 23.5 (See Graph), we still have work to do.  The initial reduction cannot be attributed to any particular effort(s) and we will continue to be diligent and innovative in this endeavor.   Some readmissions are not preventable and fevers are a big barrier.  In the near future we hope to create a working group with other institutions, focus on the patients who are readmitted frequently, and develop criteria to define what a true preventable readmission is.

Graph