Reducing 30-day “All Cause” Readmission in a Medical Unit

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Advisor: James Pelegano, MD, MS


Readmissions to the hospital within 30 days has been a major focus for hospitals across the US after the Center for Medicare and Medicaid Services (CMS) began, on October 1st 2012, to penalize hospitals for higher early readmission rates for heart failure, Acute MI and pneumonia. It is anticipated that these penalties will increase and expand to include other diseases, making this provision one of the most severe penalties mandated by the Patient Protection and Affordable Act. Hospitalists have become an almost universal presence across all U.S. hospitals with responsibility for coordinating the care for most acute inpatients. This study was conducted in an inner city, tertiary care 550-bed not-for profit hospital in which hospitalists take care of over 90 percent of all patients admitted to the Medicine Services and co-manage close to 15-20 percent of patients on the surgical services. A high readmission rate was identified as a significantly problem in January 2013. A localized poly-chronic comprehensive medical unit based hospitalist team was created in Feb 2013 as a strategy to reduce the 30-day all cause re-admissions rate. The localized unit was designed along the Comprehensive Unit Based Program and process changes included daily multi-disciplinary rounds and hand-off rounds amongst hospitalist at change-of-shift times. Readmission rates for the localized unit prior to localization (late 2012-early 2013) were compared post localization rates (spring-summer 2013). Localizing Care by hospitalists resulted in a significant drop in 30 day all cause readmission rate. The average 30-day Readmission rate dropped 20 % from 13.65 % to 10.95 % for the 6 months post-Intervention when compared to the 6-months pre-Implementation. Reducing hand-offs among clinicians and increased communication resulting from Multidisciplinary Team based rounding is proposed as an explanation for the drop.In conclusion a geographically localized model of hospitalist care can reduce Readmission Rates. This model of care should be explored further as a possible Value-driven design alteration in the Acute Inpatient environment.

Presentation: 25 minutes

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