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Readmissions and the Quest for Clinical Excellence

​​​​This month, I wanted to take a few moments to discuss our quest for sustainable clinical excellence, and, more specifically, explore readmissions as one measure of that journey. Tremendous work has been done to improve this statistic, yet I hear some people questioning if this is really about quality or just chasing numbers.  

​Let me add some context to this discussion to brighten our understanding of the challenge: This year we are on a trajectory to have some 19,000 patients (roughly 10%) readmitted to our hospitals within 30 days of discharge – many within just 1-2 days of being sent home. While it is impossible to know which ones were entirely avoidable, experts would argue that as many as a third, to even half, could be avoided in certain situations. 

To that point, there are examples of decompensated heart failure patients being discharged with BNPs no better than when they were admitted. There are examples of patients not filling or not properly taking their medications, and countless examples of patients with questions who either can’t get a time-appropriate follow up in the office, or cannot get a time-appropriate call back from the office or provider.  

Each of us knows this happens, yet we are all so busy that we do not consistently strive to make it better for all of our patients all of the time. If any of you have been a recent patient or had a family member who became a patient, you know that you, in some way, became a care navigator on their behalf. I am not making societal excuses, but rather pointing out how real and personal a challenge this is. 

Let us address the elephant in the room and rally to the occasion and make care transitions better.  We have lifted up virtual care managers, pharmacists, social services, case managers, advanced care practitioners and numerous resources – yet there is no substitute for the physician getting it right the first time. 

Help us make a difference in avoidable readmissions. If you are discharging a patient to a different provider, make sure you have effectively communicated the specifics of their care plan and the timing of their follow up. If you are picking up the continuity of that care, demand this level of communication and verify that your offices are getting these people seen. There is no substitute for doctors talking to doctors with these handoffs. We cannot simply rely on progress notes or scheduling systems. Instead, we need to treat these patients the way we ourselves want to be treated. Clearly, this is a sizeable and complex challenge, but one I believe we are ready to take to the next level of performance.  


 

 

Readmissions and the Quest for Clinical Excellence