How to Identify Patients with a High Readmission Risk

Apr 11, 2018

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Patient readmissions cost hospitals hundreds of millions of dollars every year. Not only are hospitals seeing their medicaid and medicare payments reduced, but the Centers for Medicare & Medicaid Services (CMS) routinely withhold reimbursements to hospitals who cannot keep their readmission rates under their specified level.

One of the best preventative measures hospitals can take is to focus on identifying which patients are most likely to readmit, then take effective steps to prepare them for discharge.

How can hospitals identify patients who are a high risk for readmission? They generally meet one or more of the following conditions:

Patients Who Are Uninsured or Insured Through Medicaid/Medicare

A study by the Agency for Healthcare Research and Quality found that patients who did not have insurance, or those who were insured through either Medicaid or Medicare, had much higher readmission rates than patients who were covered by private insurance. The study found that patients ages 45-64 were re-hospitalized about 60 percent more often than uninsured patients and about twice as frequently as privately insured patients. Readmissions rates in general were higher across all ages groups for those who were not covered by private insurance.

Patients Who Don't Keep Follow Up Appointments

The University of San Francisco conducted a study in 2016 that found half of preventable readmissions are due to factors that occur after discharge. One of the major signs was patients who could not keep follow-up appointments. Patients who kept missing these appointments were more susceptible to readmissions.

To help prevent this, provide a clear post-discharge plan that includes occasional follow-up calls, emails, etc. to patients. These occasional follow-ups allow communication about further instructions to discharged patients and help make sure they are doing well. They can also be used to make sure patients plan on attending their future appointments.

Patients Who Exhibit Confusion Regarding Treatment Information

The University of San Francisco study also found that many patients who made a return trip to the hospital lacked awareness of the details of their treatment as well as their initial discharge instructions. Patient frequently didn't know:

  • Who to contact should they encounter problems after discharge

  • Their overall post-treatment goals

  • Their discharge instructions and what they can do at home

Research has shown that more than a quarter of hospital readmissions could have been avoided with better communication. This is because being discharged from the hospital is often concerning to patients when they do not know what to expect. Patients suffering from post-treatment anxiety are far more likely to return to treatment centers for further care. Providers can alleviate these concerns by effectively presenting all necessary information throughout treatment and at the time of discharge. Using tools like patient whiteboards to outline the goals of treatment keeps patients informed of their progress throughout their hospital stay.

When it comes time for patients to be discharged, outline discharge goals and instructions and supply patients with a copy to take home with them. This will help patients understand what does and does not require a return trip to the hospital, thus reducing readmission rates.

Learn More About Patient Whiteboards

Patient communication is often the key to reducing patient readmissions, and there is no more effective communication tool than whiteboards. A large variety of information can be carefully conveyed using the right whiteboard solution. What kinds of treatment information can you display on a custom whiteboard? Contact our team to learn more about how our products act as a viable solution.