Reducing Readmissions

[Wonderlost]

Hi everyone,

I am currently serving as an AmeriCorps VISTA with a public health coalition in Alaska. I work with a few community groups, and the main one that I work with is at the local hospital and the goal of this group is to reduce hospital readmission rates. Before this, I worked as a CNA in an ortho hospital & on a psych unit for a bit so I have some experience in the field.

The group consists of a few administrators (DoN, ER manager, QI director), & care coordinators from outside clinics. We've been talking about the issues, reviewing HCAHP scores, and will soon be identifying some clear measurable goals/objectives. One idea that was brought up at the last meeting was implementing a teach back method to try to increase education prior to discharge, tracking this in the HCAHP survey, as well as developing a tool to assess patient readiness to discharge.

I am happy to see members of hospital administration & staff from outlying clinics in the same room to discuss these issues, but at the same time I can't help but think we are trying to solve a problem from the top down. Just going by my experience back home, trying to solve issues like this never worked. Nursing staff was never involved & no matter what the administration tried to do, their solutions never worked because the nurses just weren't involved & there was zero transparency and I am scared that is what will happen here.

My questions are: 1. How can I convince the administration that we need to get direct care staff buy in? & 2. Does anyone have any suggestions for teach back programs? I'm familiar with ask me 3 teach back but it did not seem very effective.

Thanks everyone! Any advice is appreciated. Looking forward to finishing my VISTA year in August & getting back home to finally do nursing school, but I'd like to leave knowing I made some impact with this hospital group, lol.

[RNNPICU, BSN, RN]

Actually teach back or return demonstration is one of the most effective ways for patients/families to demonstrate that they have learned the skill.

As for including a direct-care provider. There should be a few representing the different areas in the hospital. See if the hospital has a patient/family education council, or a similar hospital wide council/committee and draw staff from there.

Make sure all staff know of the data - readmission rates,etc and what the hospital goals will be, plus steps the hospital wants to take to reduce readmission rates/occurrences

[Wonderlost]

Thanks for getting back to me! Just to clarify, I know that the teach back programs are effective, I was just curious if anyone knew of any particular models that they've had good results with. The last hospital I worked in used "Ask me 3 Teachback" which I didn't see great results with, but that could also be because of other factors...

I do like the idea of sharing the data with all the staff. I'm not sure if they are already doing that, I don't actually work for them, but it would be nice to get the HCAHP scores & readmission rates out there just to encourage transparency...

[toomuchbaloney]

The reduction of readmission depends directly upon the readiness of the patient to be discharged and the ability of the patient and family to provide for the post hospital care of the patient.

Currently a good percentage of patients are discharged home because of factors unrelated to above and more related to reimbursement.

Will your discharged patients be going home to an environment with indoor plumbing?

Do they have electricity?

Will they be employing any traditional or native remedies once in the home environment?

Is the patient's home in a village (potentially remote) or in a more modern community?

Will the follow up come primarily from a village health aide, a traveling PA or NP, or from the physician in an office setting?