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Reducing readmissions

Do you know your readmissions?

Readmission is an issue that seems to be a normal fact of hospital life. However it has a high impact on the life of patients and on hospital management. How many times per year does your hospital have to urgently admit a patient within twenty eight days after a previous admission? And in addition, do you know how many costs are involved with such unplanned readmissions?

Why reducing readmission?

Readmission is one of the key outcome indicators in Reflex. In addition Valorange offers an action programme to reduce unplanned readmission. For several reasons readmission is challenge, worthwhile to tackle:

First of all, every single unplanned readmission is an undesired event from a patient safety perspective. For readmissions often come with adverse conditions like (post-operative wound) infections, embolism, hypertension or deterioration. Refraining from intervention to reduce the number of readmissions, will leave a lot of harm persistent.
Also from a managerial perspective there is a certain urge. Unplanned readmissions give capacity managers a lot headaches nowadays. Recurrences mostly come unexpected and they often require more care than newcomers. In the current situation with big shortage of nursing staff in many countries, the avoidance of readmission will be anyway a welcome relief.
Certainly, not every readmission can be avoided in the hospital. The risk of a readmission is also dependent of other healthcare providers who take over the responsibility for the patient after discharge, such as rehabs, primary care facilities, general practitioners, nursing and home care. Therefore readmission is also an indicator for the degree of integration between different care givers in the healthcare service area of a hospital. Therefore, reducing readmissions demands an approach that goes beyond the walls of the hospital. Yet, we all know that the future role of hospitals will transform to a node in an integrated healthcare landscape.
Finally, there is an economic reason for tackling readmissions, since they involve a lot of costs. Dependent of the reimbursement system in place, these costs are only partly covered by payments and, in more and more countries, not at all. From a LEAN perspective, readmission are considered as an important type of waste. Both WHO and OECD estimate that 30% of total expenditure in healthcare worldwide is wasteful. We do not know what share of healthcare waste is caused by reoccurrences but from our own measurements in The Netherlands and Brazil we know the absolute volumes are quite big.

A strong business case

An average Dutch hospital has about 35,000 clinical admissions, whereof circa 2,300 (6%) unplanned readmissions. The average length of stay of a readmission is approximately 6 days. Thus the total amount of hospital days concerned with readmission add up to almost 14,000 per year. This means that about 47 beds are continuously occupied with reoccurring patients. They require a nursing staff of 38 FTE. The annual cost of readmission are almost 7 million euro (based on average cost per nursing day of 500 euro), other costs caused by for instance re-operations or ICU days not included. A pilot study in Brazil shows similar volumes and proportions. We ought to repeat that certainly not every readmission and subsequent nursing day cannot be avoided, but one thing is sure: ignoring the problem of readmission will surely cost a hospital more than ten thousand euro every day. In the above Dutch business case, this is almost 19,000 euro per day.

Our programme to reduce readmission starts with Reflex. The tool offers the opportunity to break down the information about readmissions to all kinds of patient cohorts based on for instance diagnose, procedure, age, medical department etc. But that is only the beginning. The goal is to do something about it. There is a vast amount of proven bundles of interventions described in literature and these have been also put in practice in several hospitals all over the world. Valorange will provide you with this information and if necessary, support with you with consultancy and hands-on quality improvement.