Coming Home From The Hospital Is Actually More Dangerous Than You Might Expect

After a stressful stay in the hospital, your doctors have finally given you the green light to return home.  A sigh of relief passes over you with the realization that the worst is behind you.

Not so fast …

Coming home from the hospital is actually more dangerous than you might expect, and there is a high likelihood of readmission if proper precautions aren’t taken.  Let’s look at some of the facts from AARP’s Public Policy Institute:

• One in five Medicare beneficiaries is re-hospitalized within 30 days of discharge; one in three is readmitted within 90 days.
• More than 20% of older Americans suffer from five or more chronic conditions that account for 75% of total Medicare spending—mainly due to high rates of hospital admission and readmission.
• It is estimated Medicare spends approximately $17.4 billion in annual readmission costs.

Because of this, it’s important to find ways to improve transitional care in order to decrease the likelihood of an adverse event or readmission.

First, we need to understand some of the terms.  “Care transitions” describe the movement patients make between healthcare practitioners and environments as their condition and care requirements change.  For example, a patient might receive care from a specialist in an outpatient setting, then transition to a hospital physician and nursing team during an inpatient admission before moving on to yet another care team at a skilled nursing facility.  Finally, the patient might return home, where he or she might receive care from a visiting nurse.  Each of these shifts from care providers and settings is defined as a care transition.  “Transitional care” is the set of actions designed to ensure the coordination and continuity of healthcare, as patients transfer between different locations or different levels of care within the same location.

One group looking closely at the problem of care transitions is the Betty Irene Moore Nursing Initiative (BIMNI), funded by the Gordon and Betty Moore Foundation.  Marybeth Sharpe, BIMNI Program Director, explained, “The initiative was established to improve the experience and outcomes of patients in Northern California.  Improving the care patients receive as they transition from the hospital to their home or other care settings is one of four strategies of the initiative."  She added that, during the past 10 years, the initiative has:

• Improved patient care in more than 80% of adult acute care hospitals in the San Francisco Bay Area and the Greater Sacramento area.
• Supported 75% of San Francisco Bay Area hospitals to implement strategies to improve transitional care and reduce readmission rates.
• Achieved a 30% reduction in 30-day readmission rates and/or a 15% reduction in 90-day readmission rates in 30% of San Francisco Bay Area hospitals.

There are a number of ways that patients can be more proactive with their healthcare and improve the likelihood of successful care transitions.  Kate Weiland, Program Officer for BIMNI and an expert on transitional care, offered the following six strategies for improving the likelihood of safe, effective transitions.

1.  Understand your medications and ensure you talk to your doctor or pharmacist about how to take them.

• 26% of hospitalized patients report that medications were not explained to them, making it more challenging to adhere to the regimens when patients return home.
• According to the Centers for Disease Control and Prevention, 82% of all American adults take at least one prescription medication, and 29% take five or more.
• The average Medicare Part D patient filled 49 standardized 30-day prescriptions in 2010.

2.  Make sure to schedule and go to follow-up appointments with your doctor.

• There are various reasons why patients do not schedule or attend follow-up appointments, with statistics in the range of 5 to 55% on no-shows.
• Scheduling a follow-up doctor’s appointment before leaving the hospital can reduce a patient’s risk of being readmitted to the hospital unnecessarily.

3.  Find out if your hospital offers home visits or makes follow-up calls.

• Follow-up phone calls or home visits from a health care professional can help reduce the risk of being readmitted to the hospital.
• Patients who received a follow-up discharge call were 23% less likely to be readmitted within 30 days of leaving the hospital.

4.  Inquire about referrals to community services, such as free transportation to follow up appointments and Meals on Wheels, and take advantage of them.

• Individuals who live alone, who are unemployed, or who have challenges affording healthcare are more likely to be readmitted.
• Compared to patients with extensive social networks, hospital readmission was more frequent among those who had moderate to negligible social networks.

5.  Ensure anyone taking care of you is engaged in all conversations throughout your healthcare experience.

• 40 to 80% of medical information provided by health care practitioners is forgotten by patients immediately.
• Nearly 20% of patients said their health had suffered due to poor communication for varying reasons.
• 52 million informal caregivers provide care to adults (aged 18+) with a disability or illness.

6.  Clearly know your instructions when leaving the hospital, and if you are unsure, ask, ask, ask - and ask again.

• Roughly 23% of hospitalized patients report they were not given information about what to do when recovering at home.
• Only 12% of adults have proficient health literacy, which means that nearly nine out of ten adults may lack the skills needed to manage their health and to prevent disease.

It’s still okay to look forward to the day you are well enough to leave the hospital.  But paying attention to the details of your transition can help make sure you don’t end up right back in that same hospital bed.