Assessing the Problem: Preventing Readmissions to Hospitals for Chronic Conditions
Hospital readmission rates continue to surge across healthcare systems in response to unprecedented public health concerns. After hospitalization, patients often continue dealing with chronic conditions and may face difficulties while navigating their treatment plan. Research supports that frequent readmissions often relate to underlying chronic problems (Butt et al., 2020; Myers et al., 2020). Although patients should be free from unplanned readmissions, it remains a major concern in terms of patient safety and quality of care. Minutello et al. (2018) provide evidence that readmission is burdensome and costly for hospitals and patients since more resources are needed to cater to new health needs. The paper evaluates the effectiveness of care interventions for patients with chronic health problems in preventing hospital readmission. The number of people with chronic health problems grows as the demand for care services mounts, creating new challenges in the delivery of safe and quality care. Therefore, addressing factors linked to hospital readmissions while caring for diverse populations should be a central concern for the healthcare system.
Impact on Quality of Care, Patient Safety, and Cost
Central to the adverse events arising after patient discharge are systematic problems in care and safety. Health professionals can change patient medication or treatment during hospitalizations. However, a lack of treatment reconciliation can potentially result in medication discrepancies after discharge, particularly among patients with complex treatment regimens (Killin et al., 2021). Apart from adverse treatment events, procedural complications and hospital-acquired infections such as ventilator and non-ventilator hospital-acquired pneumonia can result in heightened morbidity due to readmissions (Sanchez-Muñoz et al., 2020). Post-discharge complications often arise when patients get discharged with pending test results and a diagnostic plan, placing patient safety and care at risk unless health providers ensure timely follow-ups.
Furthermore, discontinuity of outpatient and inpatient health professionals can result in readmission. Abu et al. (2018) mention that outpatient providers may fail to get timely patient data leading to health consequences after discharge. In addition, the hospital environment significantly contributes to the increasing readmission rate. For example, post-hospitalization syndrome can leave patients vulnerable to adverse events after discharge, like infections (Flash et al., 2020). A safe and supportive healthcare environment reflects vigilance and compassion for patients, and the converse is true. Poor hospital environments place patients at risk during and after hospitalization. Room features, ventilation, lighting, and visibility of medical equipment include environmental factors that affect care outcomes.
While a good hospital environment plus timely and accurate communication between providers and patients can ensure treatment safety, hospitals and patients still face care burdens after discharge. Failure to accurately assess patients’ abilities to successfully transition from a hospital to another care setting can make them vulnerable to adverse events upon discharge. Penney et al. (2018) asserted that the complex and fragmented nature of care delivery might limit hospitals’ incentive to reduce readmission because of the financial impact. Improving discharge processes demands an increase in operating costs because of the greater use of medical resources (Goel et al., 2019; Minutello et al., 2018). Likewise, patients face higher expenses during readmission, especially when treating chronic diseases like cancer and diabetes. Therefore, interventions on preventing readmission should focus on patient safety, care and cost.
State Board of Nursing Practice Standards and Governmental Policies
Hospitals and health advocates must prioritize efforts to prevent and reduce readmissions. In efforts to prevent hospital readmission, a state board of nursing decides the scope of care delivery and patient safety. While all state boards maintain similar standards for nursing, each state establishes and passes its own law and nursing regulations. For example, the Texas Board of Nursing provides guidelines to nurses on carrying out orders from other licensed health providers (Thomas, 2021). The standards allow nurses to seek clarification if they believe the order of treatment might be inaccurate, which can potentially result in readmission. Likewise, the Florida Board of Nursing educates licenses, and monitors nurses to ensure their competencies in providing quality care (Porto, n.d.). Thus, the state board of nursing plays a central role in continued competency among nurses and other healthcare professionals in reducing readmission.
Furthermore, the Patient Protection and Affordable Care Act (ACA) compels providers to continue innovation in the provision of safe, accessible, and quality care. The ACA provides a legislative framework linking care and payment initiatives (Han et al., 2018). Readmission can be costly since hospitals due to the expansion of regulations and medical resources to prevent low quality care, which might result in readmission. ACA highlights regulatory requirements that serve as a platform for nurses and providers to share expertise in planning patient treatment plans. Thus, the Act accelerates the development of care competencies while enhancing policy and administrative skills in healthcare practice (Han et al., 2018). As such, providers contribute to the development of novel solutions through the implementation of health policies and programs, including the Hospital Readmission Reduction Program.
The Patient Protection and Affordable Act contains several payment reforms in addressing adverse events after hospital discharge. According to Buhr et al. (2022), primary among the reforms is the HRRP which allows the Centers for Medicare & Medicaid Service (CMS) to financially penalize health institutions with higher-than-expected readmissions for target health conditions such as chronic obstructive pulmonary disease, pneumonia, acute myocardial infarction, and heart failure (Myers et al., 2020). Although the program disproportionately penalizes hospitals caring for vulnerable populations, it allows health institutions to receive bundle payments, providing a financial incentive for care continuity. Therefore, the HRRP ensures hospitals reduce readmissions by optimizing care transition, improving patient communication, and maintaining a positive reputation for care quality.
Strategies to Improve Quality of Care, Enhance Patient Safety & Reduce Costs
Hospital readmission significantly affects the delivery of safe, cost-efficient, and quality care. Interventions to prevent readmission begin with transforming the healthcare environment. Healthcare leaders should seek to invest in quality and treatment strategies through an integrated system that improves hospital environments. When approaching post-discharge issues, providers often focus on the patient’s underlying health problem. Fatima et al. (2018) asserted that improving hospital environments can substantively impact patient experience and satisfaction with the treatment plan. For example, providers can foster a culture of empathy that reinforces communication and coordination that extends to the nursing staff. Hospital policies further impact hospital environments and as a consequence, prevent readmission. For example, policies such as noise control, room temperature, and lighting affect patient comfort since most individuals would request to get discharged if the hospital environment fails to support quick recovery (Sokol et al., 2022). Improvements in hospital environments directly affect the delivery of quality care, preventing adverse effects after discharge. Additionally, hospitals can move toward patient-centered approaches that include patients in every aspect of care.
Another intervention is incorporating evidence-based practice (EBP) in the healthcare system. EBP aims at providing effective care to improve health outcomes. Providers must deliver the most effective care based on informed and available evidence. Lehane et al. (2019) stated that EBP promotes communication and collaboration among health professionals, influencing decision-making based on the best medication and treatment plan for successful patient discharge. Moreover, EBP ensures appropriate use of health resources and that patients consider relevant evidence on their health. Thus, EBP integrates patient preferences, evidence, and clinical expertise for individualized care (Lehane et al., 2019; Xu et al., 2020). Through personalized medication reconciliation that emphasizes follow-up appointments, hospitals can ensure that patients receive post-discharge support and help them understand when to seek additional or appropriate care. Likewise, hospitals with low readmissions seek smooth patient transition after discharge to avoid health deterioration that forces patients back to the hospital. In this view, EBP involves workforce innovation by developing new provider roles and promoting effective use of hospital resources to manage patient needs to prevent readmission.
Technological innovation provides practitioners with the tools for creating high care levels. For example, providers and nurses must understand the challenges of preventing hospital readmission. Innovative approaches like the use of electronic health records (EHS) can help verify patient data during discharge (Liu et al., 2018). In terms of follow-ups and effective communication between providers, videoconferencing platforms provide concise solutions. Plus, these tools make it easy for providers to check up on their patients without the inconvenience of frequent hospital visits, and thus, real-time consultations (Koraishy & Rohatgi, 2020). For instance, chronic wounds can lead to multiple readmissions. Through communication tools, care experts can guide care nurses on how to provide treatment, minimizing the readmission rate. Innovative approaches essentially improve discharge planning and coordination for patient follow-up.
Nursing interventions on admission, throughout hospitalization, and during discharge support efforts toward the prevention of hospital readmissions. Nurses can mitigate readmission at various points of the healthcare delivery system. For instance, nurses can appropriately determine patients’ discharge readiness. The compilation of accurate and comprehensive patient data influences discharge approval and nurses should ensure the discharge summary reflects the correct patient’s health status (Mileski et al., 2020). As such, nurses must coordinate with providers to determine the most appropriate post-discharge setting that meets the patient’s needs. Additionally, nurses must involve patients and their families in the care plan to identify concerns that demand additional intervention before discharge (Mileski et al., 2020; Nurhayati et al., 2019). Therefore, through efficient communication, planning, and coordination, nurses can help other providers minimize readmission risks, as per nursing practice standards.
I will be working with the parents of a 14-year-old boy, recently diagnosed with leukemia. While leukemia is often common in children, older adults are also at risk. Leukemia is a type of cancer that targets blood-forming tissues such as the lymphatic system. White blood cells typically fight against infections, but people with leukemia produce an excessive amount of white blood cells that do not function well. Leukemia symptoms vary, but common signs include fever, severe infections, weight loss, swollen lymph nodes, recurrent nose bleeds, and bone tenderness. In addition to these symptoms, my patient exhibits recurrent nosebleeds and persistent fatigue. While the exact cause of leukemia has not been established, a combination of environmental and genetic factors increases one’s risk of developing leukemia. Previous cancer treatment, smoking, family history, genetic disorder, plus exposure to chemicals can increase a person’s risk of developing leukemia. My patient’s uncle was diagnosed with leukemia twelve years back; thus, evidence of a family history of leukemia. I discussed with the parents the risk factors and their impact on the diagnosis. With an understanding of the patient’s health needs, we discussed an early treatment plan and how insurance can help cover chemotherapy and other treatment plans.
Abu, H. O., Anatchkova, M. D., Erskine, N. A., Lewis, J., McManus, D. D., Kiefe, C. I., & Santry, H. P. (2018). Are we “missing the big picture” in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization. Applied Nursing Research, 44, 60-66. Web.
Buhr, R. G., & Krishnan, J. A. (2022). Yet Another Crack in the Façade of the CMS Hospital Readmissions Reduction Program for COPD. American Journal of Respiratory and Critical Care Medicine, (ja). Web.
Butt, J.H., Fosbøl, E.L., Gerds, T.A., Andersson, C., McMurray, J.J., Petrie, M.C., Gustafsson, F., Madelaire, C., Kristensen, S.L., Gislason, G.H. and Torp‐Pedersen, C. (2020). Readmission and death in patients admitted with new‐onset versus worsening of chronic heart failure: insights from a nationwide cohort. European Journal of Heart Failure, 22(10), pp.1777-1785. Web.
Fatima, T., Malik, S. A., & Shabbir, A. (2018). Hospital healthcare service quality, patient satisfaction and loyalty: An investigation in the context of private healthcare systems. International Journal of Quality & Reliability Management. Web.
Flash, M. J., Johnson, S. F., Nguemeni Tiako, M. J., Tan-McGrory, A., Betancourt, J. R., Lamas, D. J., & Alba, G. A. (2020). Disparities in post-intensive care syndrome during the COVID-19 pandemic: challenges and solutions. NEJM Catalyst Innovations in Care Delivery, 1(6). Web.
Goel, A. N., Raghavan, G., St John, M. A., & Long, J. L. (2019). Risk factors, causes, and costs of hospital readmission after head and neck cancer surgery reconstruction. JAMA facial plastic surgery, 21(2), 137-145. Web.
Han, X., Yabroff, K. R., Ward, E., Brawley, O. W., & Jemal, A. (2018). Comparison of insurance status and diagnosis stage among patients with newly diagnosed cancer before vs after implementation of the Patient Protection and Affordable Care Act. JAMA oncology, 4(12), 1713-1720. Web.
Killin, L., Hezam, A., Anderson, K. K., & Welk, B. (2021). Advanced medication reconciliation: a systematic review of the impact on medication errors and adverse drug events associated with transitions of care. The Joint Commission Journal on Quality and Patient Safety, 47(7), 438-451. Web.
Kim, L.K., Yeo, I., Cheung, J.W., Swaminathan, R.V., Wong, S.C., Charitakis, K., Adejumo, O., Chae, J., Minutello, R.M., Bergman, G. and Singh, H. (2018). Thirty‐Day readmission rates, timing, causes, and costs after ST‐Segment–Elevation myocardial infarction in the United States: a national readmission database analysis 2010–2014. Journal of the American Heart Association, 7(18). Web.
Koraishy, F. M., & Rohatgi, R. (2020). Telenephrology: an emerging platform for delivering renal health care. American Journal of Kidney Diseases, 76(3), 417-426. Web.
Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., O’Connor, M., Corrigan, M., Burke, F., Hayes, M. and Lynch, H. (2019). Evidence-based practice education for healthcare professions: an expert view. BMJ evidence-based medicine, 24(3), pp.103-108. Web.
Liu, J., Zhang, Z., & Razavian, N. (2018, November). Deep ehr: Chronic disease prediction using medical notes. In Machine Learning for Healthcare Conference (pp. 440-464). PMLR.
Mileski, M., Pannu, U., Payne, B., Sterling, E., & McClay, R. (2020, June). The impact of nurse practitioners on hospitalizations and discharges from long-term nursing facilities: a systematic review. In Healthcare (Vol. 8, No. 2, p. 114). Multidisciplinary Digital Publishing Institute.
Myers, L. C., Faridi, M. K., Hasegawa, K., Hanania, N. A., & Camargo Jr, C. A. (2020). The hospital readmissions reduction program and readmissions for chronic obstructive pulmonary disease, 2006–2015. Annals of the American Thoracic Society, 17(4), 450-456. Web.
Nurhayati, N., Songwathana, P., & Vachprasit, R. (2019). Surgical patients’ experiences of readiness for hospital discharge and perceived quality of discharge teaching in acute care hospitals. Journal of clinical nursing, 28(9-10), 1728-1736. Web.
Penney, L. S., Nahid, M., Leykum, L. K., Lanham, H. J., Noël, P. H., Finley, E. P., & Pugh, J. (2018). Interventions to reduce readmissions: can complex adaptive system theory explain the heterogeneity in effectiveness? A systematic review. BMC health services research, 18(1), 1-10. Web.
Porto, A. L. (n.d.). State of Florida Board of Nursing.
Sanchez-Muñoz, G., López-de-Andrés, A., Hernández-Barrera, V., Pedraza-Serrano, F., Jimenez-Garcia, R., Lopez-Herranz, M., Puente-Maestu, L. and Miguel-Diez, J.D. (2020). Hospitalizations for community-acquired and non-ventilator-associated hospital-acquired pneumonia in Spain: influence of the presence of bronchiectasis. A retrospective database study. Journal of clinical medicine, 9(8), p.2339. Web.
Sokol, N., Kurek, J., Martyniuk-Peczek, J., Amorim, C.N.D., Vasquez, N.G., Kanno, J.R., Sibilio, S. and Matusiak, B. (2022). Boundary conditions for non-residential buildings from the user’s perspective: a literature review. Energy and Buildings, p.112192. Web.
Thomas, K. (2021). Texas Board of Nursing. Nursing, 2, 4.
Xu, G., Yang, Y., Du, Y., Peng, F., Hu, P., Wang, R., Yin, M., Li, T., Tu, L., Sun, J. and Jiang, T., 2020. Clinical pathway for early diagnosis of COVID-19: updates from experience to evidence-based practice. Clinical reviews in allergy & immunology, 59(1), pp.89-100. Web.