Strategies for reducing hospital readmission rates

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published August 31, 2022

Key Takeaways

  • Only a minority of hospital readmissions are preventable, but efforts at prevention are still worthwhile.

  • In the age of COVID-19, videoconferencing can involve caregivers in discharge decisions and thus possibly lower readmission rates. Caregivers can observe the patient and ask about their functional status, as well as discuss home care.

  • When screening patients for discharge, it’s important to consider multiple components and pay special attention to high-risk patients.

Unplanned readmission rates are bad for hospitals, because this measure can negatively impact Medicare reimbursement.

Readmission rates were of particular concern during the pandemic, when hospital systems were overtaxed. But there are strategies hospitals can use to decrease at least some unplanned readmissions.

The problem with readmission rates

An Agency for Healthcare Research and Quality study found that 3.8 million adult hospital readmissions occurred within 30 days of admission in 2018; the average readmission rate was 14% at an average cost of $15,200 per readmission.[] Patients on Medicare and Medicaid are more likely to be readmitted than those with other insurers.

Policy makers view unplanned readmission rates as a proxy for quality of care, reflected in discharge management, care transitions, and patient engagement.

Medicare uses hospital readmission rates to determine reimbursement via the Hospital Readmissions Reduction Program, which is part of the Affordable Care Act. (More specifically, hospitals can be penalized for higher readmission rates.)

The issue with hospital readmission rates is that they don’t adequately adjust for risk or other complications. Even before the COVID-19 pandemic, studies showed that only 25% of hospital readmissions are preventable. A Harvard Medical School study published in The Joint Commission Journal on Quality and Patient Safety conducted during the pandemic showed that only 25% of 30-day hospital readmissions of COVID-19 patients were preventable.[]

"This study suggests that although most revisits of patients admitted with COVID-19 during the study period were not preventable, there were several key opportunities for improvement."

Taupin, et al.

“These findings have led to the development of interventions designed to reduce hospital revisits for patients with COVID-19 at our institution. These lessons could also be applied to help prevent revisits in the future, in both pandemic and non-pandemic conditions,” the authors added.

Lowering readmissions

Based on their research findings, the authors of the Harvard study adjusted their practices accordingly. For instance, they developed a hospital-wide interdisciplinary guideline for discharging COVID-19 patients in the context of the pandemic.

In particular, it offered strategies on how to enhance self-management planning at discharge, one of the most important factors identified as affecting readmissions both related and not related to the pandemic. These strategies include the use of videoconferencing with the care team, patient, and caregivers in attendance.

Video is important because it allows caregivers (who may not be able to come into the hospital) to voice their concerns about the patient’s current functional status—which may have declined—and their own ability to care for the patient at home.

Other points made in the guideline included use of a standardized workflow for discharge medication, prescriptions, and patient education. It also had a checklist of topics for the team to discuss in interdisciplinary rounds to ensure that the patient had adequate resources available if they needed to self-isolate.

The researchers also highlighted the importance of chronic-disease management in COVID-19 patients. Many of the readmissions were due to exacerbation of conditions such as diabetes, renal disease, and heart failure. Worsened respiratory symptoms accounted for only 11.8% of hospital readmissions.

Interventions as solutions

In an effort to decrease hospital readmission rates, institutions could employ interventions that encompass multiple components, such as medication reconciliation, patient needs assessment, and timely outpatient appointments, according to authors publishing in the Annual Review of Medicine.[]

The authors also recommended using checklists or models that identify high-risk patients. These patients frequently are characterized by advanced age, multiple comorbidities, functional impairment, and decreased healthcare utilization.

In addition, US researchers studying a family-medicine inpatient service found that high-frequency readmission cohorts were often diagnosed with psychiatric disease, substance use disorder, or chronic pain. They described their findings in an article published in the Journal of the American Board of Family Medicine.[]

Among patients who experienced three or more readmissions to the hospital in a calendar year, the prevailing characteristics (in addition to the conditions noted above) were younger age, being single, and having a longer list of medications and problems.

"A further evaluation of these characteristics," the authors wrote, "may provide additional information and allow the ability to intervene earlier with patients before the readmission.”

What this means for you

Although hospital readmissions may be an imperfect benchmark of treatment success, there are ways to improve this metric. Teams can use checklists or models to predict risk of readmission and focus on high-risk patients. Self-management planning at discharge is very important. Videoconferencing is a useful tool for meeting with caregivers in the context of COVID-19 and addressing their concerns and capabilities related to the patient's care. Caregivers can give a better idea of baseline status, and whether the patient will receive proper care at home.

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