Reducing patient readmission for seniors is a priority for hospitals, home care providers, physicians, and healthcare professionals alike. Avoiding unnecessary and costly re-hospitalization can come down to the simplicity of communicating and collaborating with each other.
Readmission Prevention Strategies
Many seniors are at risk for readmission due to:
- Poor diet
- Medication side effects or misuse
- Lack of support at home
- Misunderstanding of hospital instructions
- Chronic conditions
Predicting which seniors are at a higher risk for readmission is not an exact science. And yet, there are some things that healthcare professionals can be proactive at when addressing hospital re-entry.
Start care management as soon as possible.
Communication and coordination between hospitals and home care provider should begin before a patient becomes discharged.
Clearly state post-discharge directions.
Dialogue and education are a core component of readmission prevention. Utilize the "show me" aka the teach-back method to ensure a patient understands his/her health condition. Being able to educate patients and family members with this technique are useful for proper provider-patient communication.
Follow up regularly.
The lack of monitoring after being discharged is a common reason for re-hospitalization. Care coordinators should stay in contact with patients and or home care providers frequently.
Improve training for HCP personnel.
Home care services that offer their caregiving staff an ongoing training curriculum that helps address and recognize changes in a resident's health will aid in reducing hospital admission and readmission.
Understand readmission types and causes.
Determining which variety of readmission to focus on is critical as each will vary dramatically. Some re-entries will be the responsibilities of the hospital because of something that happened there. Other readmittance will be because patients are not receiving proper primary care within their community (ALF, SNF, HCP).
Utilize health information technology.
Being able to manage the exchange from inpatient to outpatient continues to be a barrier to primary care physicians and home care providers. Health information technology allows care professionals to access medical records quickly and relay that information to the proper care providers.
The combination of communication, coordination, and education of all involved are keys to preventing and reducing readmissions for seniors. To learn more about hospital readmission prevention, refer to our Guide to Avoiding Preventable Hospital Visits.