Improved Communication Can Reduce Hospital Readmissions

More than one-fourth of readmissions are potentially preventable and may be avoided with improved communication among healthcare teams and with patients.

A study from University of California, San Francisco (UCSF) examined hospital readmissions for general medicine patients in order to gauge the preventability of these readmissions and the contributing factors to readmissions, in addition to indicating areas of improvement.

The researchers reviewed 1000 cases of general medicine patients readmitted to a medical center within 30 days of discharge, focusing on whether readmission was potentially preventable, and what motivated readmission, regardless of preventability.

They used patient interviews and physician surveys—with at least 1 survey per patient case—during the period between April 1, 2012, and March 31, 2016. Patients were US adults ages 18 and older with English as their primary language. Medical record-based measures were established based on proposals from the National Quality Forum’s Care Coordination Measures. Participating hospitals included UCSF, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, California Pacific Medical Center, Christiana Care Health System, Northwestern Memorial Hospital, Zuckerberg San Francisco General Hospital and Trauma Center, University of Chicago, University of Michigan Hospital, University of Pennsylvania, University of Washington Harborview Hospital, and Vanderbilt University.

During the review process, researchers were told to look especially for system flaws and gaps in care—namely, readmissions that would not have occurred in an ideal health system. They were told to classify cases as potentially preventable if preventability appeared to be 50% or higher.

The report determined that 26.9% of cases were potentially preventable, half of which were credited to gaps in care during the initial stay. Factors associated with readmissions were: inadequate treatment of symptoms other than pain, inadequate monitoring of adverse effects of medication or non-adherence with medication, follow-up appointments not scheduled sufficiently soon after discharge, patient lack of awareness of help contacts or when to go for emergency care, patient need for additional or different home services than originally offered in discharge plan, discharge of patient too early, issues related to hospital decisions on readmitting patients, failure to relay important information to outpatient healthcare, lack of discussion about care goals with severely ill patients, and inability of patients to attend follow-up appointments.

“Overcoming this gap requires improved communication between primary providers and hospital physicians about readmission criteria, as well as greater access to urgent care facilities, or short-term units such as chest pain clinics, for patients who would otherwise seek emergency department services,” lead author Andrew Auerbach, MD, MPH, a hospitalist with UCSF Health and a professor of medicine, said in a statement.

The authors said that further research is required in order to determine if eliminating these factors would reduce readmissions. There is not enough data on a national level regarding the frequency of readmissions preventability particularly on whether or not specific care processes, patients’ needs, or comorbidities are associated with preventability.

“Hospitals need to work with outpatient providers to improve communications and jointly come up with comprehensive programs to keep patients safe after discharge,” senior author Jeffrey Schnipper, MD, MPH, said. “This requires investment, but it’s a better alternative than paying penalties.”