Saline Memorial Hospital made changes to routine practices to reduce readmissions.
Organization Type: Hospital, Non-profit
Number of Beds: 177 beds
Model Type: IHI Transforming Care at the Bedside
Saline Memorial Hospital (SMH) has been a part of the Arkansas Hospital Association Hospital Engagement Network (HEN) since its inception in 2012. Although our hospital’s multidisciplinary team has grown and changed over the years, we pride ourselves on working together to make a difference in the safety of our patients and community. When the HEN presented readmissions as one of its quality improvement initiatives, it was an area we hadn’t thought about or believed we could make an impact. Although we didn’t think readmissions was a problem, we asked our IT department to create and send a report each morning, showing the number of readmissions from the day before. That’s when our eyes were opened! When we first started collecting readmissions data, the numbers seemed overwhelming and too big to overcome. But we remembered the story about “how to eat an elephant… just one bite at a time” and that’s what we did.
What We Tried
Our hospital implemented many changes, including:
• Educating physicians about all-cause readmissions
• Making follow-up phone calls within 24-48 hours after discharge, handled by our quality department
• Implementing a new readmission risk assessment, done by case managers
• Educating front-line nurses about using teach-back techniques for discharge instructions
• Creating a daily readmissions report for administration, case managers, quality department
• Scheduling quarterly transitions of care meetings with area long-term care facilities, rehabilitation, hospice, home health, etc.
• Developing a home health program to follow pneumonia, AMI, CHF and COPD (core measure) patients at home for 30 days
In 2012, our baseline readmission rate was 11.3 percent, and our goal was to reduce readmissions to 9 percent by December 2013. Through the efforts of our HEN team members, physicians and ancillary staff, our readmission rate average was 7.1 percent by the end of the first HEN project.
The start of HEN 2.0 revitalized our team to look at readmissions with fresh eyes. HEN 2.0 called all hospitals to reduce readmissions by 20 percent once again; because of the positive outcomes our hospital had from the first phase of the HEN initiative, our new goal is 6 percent. Some of our team members attended the readmission workshop in Little Rock, Ark., in January 2016, and from that meeting, we took away some great ideas to use at SMH. We started having our hospital pharmacy review each readmission for possible causes. In addition, a quality staff member interviews each readmission patient prior to discharge to ask “why do you think you were readmitted?” and “what can we do to keep you healthy and at home this time?” We are gathering great data and are almost ready to present information to our nurses and physicians, which may help them in the future with decision making about discharges.
Learning, education and communication are the keys to improving patient outcomes. In the beginning, we didn’t realize we had a problem. We were simply taking care of our friends and neighbors and not thinking about how often they were coming into the hospital. For the safety of our patients, and also to combat the financial penalties of readmissions, it is vital that we strive to keep these patients at home. We are continuing our work:
• Educating patients on how they can stay healthy when they go home—taking their medications as prescribed, eating a proper diet, following up with their primary care physician, etc.
• Informing patients about new medications they receive in the hospital, so when they go home they understand possible side effects— possibly preventing them from returning to the hospital.
• Teaching patients and caregivers or families to look for signs and symptoms that might signal they need to go see their primary care physician earlier than scheduled.
Communication is vital—communication between health care providers, patients, community resources and back, completing that loop. We must communicate with each other to provide the best care possible for the patient.
Health care is a journey for the patient and the health care provider. Sometimes it is overwhelming for all parties involved. It is comforting to know we are partnering with the American Hospital Association and have resources available through the HEN to better serve our patients and community.