While hospitals across the country are looking for new ways to bring readmission rates down, nurses at California Hospital Medical Center in Los Angeles have developed a new tool to reduce hospital readmissions.
“We were looking for a way to improve on our generic readmission checklist that is completed on a patient’s admission to the hospital,” said Gladys Castro, RN, nurse manager on the med/surgical unit at California Hospital Medical Center. “The med/surgical unit has the highest volume of readmissions, so we formed a committee to develop a tool that would identify risk factors for patient readmission.”
Within two weeks the committee had developed the high risk readmission form, which is filled out upon a patient’s admission to the hospital. It includes questions that assess each patient’s mobility, risk of falls, whether they use oxygen, age and other factors. If a patient is identified as being high risk, then the admitting nurse will put in an order for a case manager to review the case.
“Our goal was to determine why patients were being readmitted to the hospital,” Castro said. “We wanted to identify obstacles such as oxygen that might not have been ordered early enough, or patients not having an adequate discharge destination where they would receive proper care.”
Identifying those at risk
Castro and her colleagues hoped to develop a tool that could easily be adapted for use in discharge planning to predict a patient’s risk of future hospital readmission.
The committee at California Hospital Medical Center found patients with chronic diseases such as asthma, diabetes, and heart failure were being readmitted within 30 days of their discharge, with congestive heart failure being one of the highest causes for readmission.
“We looked at the readmission metrics from quality and started to drill down to identify the discharge and admission diagnosis,” Castro said. “Using the new tool, the case manager and the nurses work collaboratively with the patient to prevent readmissions.”
While it has only been a over a year since the high risk readmission form was introduced, Castro said it’s shown promising results.
“We haven’t eliminated readmissions entirely, but we have shown a significant decrease,” Castro said.
“In addition, we’re seeing that the form is engaging staff to become agents of change. They understand the form isn’t just another piece of paper to fill out.”
Castro said the form has been tweaked twice due to staff suggestions, and that the hospital has seen staff compliance rise from 33% when the form was first introduced to 98% compliance.
The committee is looking at other ways readmissions can be reduced, such as assigning nurses to call patients after they have been discharged to answer any questions or concerns they might have, to ensure that each patient has received adequate education upon discharge regarding how to manage their condition and when to take medication.
“We’re also looking at patients who may be homeless and how we can connect them with community resources after their discharge to ensure they receive continued care,” Castro said.
The high risk readmission form also is used during the med/surg staff’s morning huddles to address any issues or problems that may have surfaced since a patient was first admitted.
“As part of our commitment to patient-centered care, we are using the form to look at what the patients need upon admission to the hospital whether it’s chronic disease education, oxygen or help getting to their appointments or getting their medications filled,” Castro said.
Since the California Hospital Medical Center serves a diverse population, Castro said staff is required to use telephone interpreters, rather than rely on a patient’s family to translate information.
“Our nurses do a fantastic job and we’re always looking for ways to recognize their efforts,” Castro said. “We have a regular Med-Surg Angel award that is driven by patient thank-you notes and a teambuilding program where nurses are encouraged to thank their colleagues for their support and teamwork.”