#readmission reduction program

By Aine Cryts

Increasing patient engagement

If healthcare providers wait until the day of a patient’s hip or knee surgery to worry about preventing readmissions, they’ve probably missed the boat, says Anthony DiGioia, MD, founder and medical director of the Patient and Family Centered Care Methodology and Practice Innovation Center at the University of Pittsburgh Medical Center (UPMC).

That’s why the medical center considers all of the processes that touch patients—from presurgical preparations such as lab testing to the surgery and the patient stay to the patient’s rehabilitation—and keeping in mind the perspective of patients and their families as they design patient care. Keeping the patient’s perspective in mind helps drive higher patient engagement, which, along with family engagement, is the best way to reduce readmissions and improve outcomes, insists DiGioia, who is also a practicing orthopedic surgeon.

DiGioia notes that patient falls—either in the hospital or at home after surgery—are of particular concern to patients and their friends and families. In response, UPMC uses the following approach, which is heavily reliant on patient engagement, to help prevent readmissions among its total hip and total knee replacement patients:

Educating patients three or four weeks before their surgery about what to expect;

Coaching patients to start their post-operative exercises three or four weeks before their surgery;

Teaching patients about the medical center’s falls prevention program; and

Encouraging patients to select a family member or a friend as a “coach.”

Put nurses back in the classroom

Newton-Wellesley Hospital, which is located 13 miles outside Boston in suburban Newton and is part of Partners HealthCare, took 20 of its nurses out of the hospital and sent them to a conference organized by the Cambridge, Massachusetts-based Institute for Healthcare Improvement (IHI), a nonprofit focused on driving healthcare improvement worldwide, to learn about ways to improve patient care.

One of the tools the nurses brought back to their patients was the “teach back” method, which involves nurses educating patients about what they should be doing once they get home after being discharged from the hospital, and then asking patients to explain those instructions in a way that the patient understands, says Bert Thurlo-Walsh, RN, vice president of quality and patient safety.

For example, nurses tell congestive heart failure patients that they need to be careful about eating foods with high salt content, as these foods may cause them to retain water and then have trouble breathing, says Thurlo-Walsh. Patients are also advised to monitor their ankles for signs of weight gain. Patients are then asked to explain what this dietary advice and monitoring of health signs means to them, says Thurlo-Walsh.

These conversations, which were once driven by a paper-driven work flow, are now built into the hospital’s EHR-driven work flow—and that alone has had increased compliance from less than 50% to more than 90%, says Thurlo-Walsh. Newton-Wellesley’s readmissions rate for all surgical procedures has gone down from 11.4% in 2012 to 10.8% as of April 2016, according to the hospital.