What is the best practice for hospital discharges to reduce readmissions?

Best Practices for Hospital Discharges to Reduce Readmissions

Implementing structured discharge planning that begins at admission and continues after discharge through multidisciplinary care coordination is the most effective approach to reduce hospital readmissions.

Key Components of Effective Discharge Planning

1. Timing of Discharge Planning

• Begin discharge planning as soon as the patient's condition is stable 1
• Start interventions during hospital stay and continue after discharge rather than starting after discharge 2
• Ensure patients are euvolemic and precipitants of admission have been treated before discharge 1

2. Patient-Centered Discharge Instructions

• Provide clear, patient-centered discharge instructions with a transitional care plan before hospital discharge 1
• Include the following elements in discharge instructions:
  • Activity level recommendations
  • Dietary guidance
  • Discharge medications with clear instructions
  • Follow-up appointment details
  • Weight monitoring instructions (especially for heart failure patients)
  • Instructions on what to do if symptoms worsen 1
  • Medication reconciliation 1

3. Follow-up Care Coordination

• Schedule early follow-up appointments, generally within 7 days of hospital discharge 1, 3
  • The largest reduction in readmissions occurs with follow-up visits within the first 10 days after discharge 3
• Ensure clear communication with outpatient providers by promptly transmitting discharge summaries 4
• Arrange follow-up appointments before discharge 1

4. Multidisciplinary Team Approach

• Refer high-risk patients, particularly those with recurrent hospitalizations, to multidisciplinary disease management programs 1
• Include various team members as appropriate: cardiologists, primary care clinicians, nurses, pharmacists, dieticians, social workers, and community health workers 1
• Use case management or nurse discharge coordinators for high-risk patients 1

5. Medication Management

• Perform thorough medication reconciliation before discharge 1
• Provide clear instructions on medication management, including proper administration technique, timing, and dose adjustments 4
• Ensure patients have access to prescribed medications before discharge 4

6. Patient Education and Empowerment

• Focus on interventions that enhance patient empowerment, which are more effective in reducing readmissions 2
• Provide standardized verbal instructions in the patient's preferred language 1
• Use written materials to improve recall of information 1
• Consider using pictograms for patients with low health literacy 1
• Teach patients to recognize warning signs requiring medical attention 4

Implementation Strategies

For Healthcare Systems

• Participate in systems that allow benchmarking to performance measures to increase use of evidence-based therapy and improve quality of care 1
• Develop standardized discharge checklists that outline necessary processes for safe discharge 5
• Consider a composite measure that incorporates readmissions, mortality, patient-reported outcomes, observation stays, and emergency department visits 1

For High-Risk Conditions

• For heart failure patients:

  • Ensure patients are euvolemic before discharge 1
  • Provide education on self-monitoring of weight and symptoms 1
  • Arrange early follow-up within 7 days 1
  • Consider referral to specialized heart failure disease management programs 1

• For diabetes patients:

  • Provide clear instructions on blood glucose monitoring 4
  • Ensure proper education on medication management 4
  • Schedule follow-up within 1-2 weeks to monitor medication tolerance and blood glucose control 4

Common Pitfalls to Avoid

• Discharging patients before optimal volume status is achieved 1
• Sending patients home without life-saving therapies or adequate medication reconciliation 1
• Failing to provide adequate control of conditions like hypertension or atrial fibrillation 1
• Delaying diagnostic testing until outpatient follow-up 1
• Focusing solely on reducing readmissions without considering mortality outcomes 1
• Neglecting to address patient-specific barriers to care such as health literacy, cognitive impairment, or psychosocial support 1

Evidence of Effectiveness

• Communication interventions at discharge are associated with 31% lower readmission rates, 24% higher treatment adherence, and 41% higher patient satisfaction 6
• Hospitals with early physician follow-up after discharge show reduced 30-day readmission rates 1
• Discharge planning quality is associated with lower rates of 30-day hospital readmissions 7
• Interventions starting during hospital stay and continuing after discharge are more effective than those starting after discharge 2

By implementing these evidence-based discharge practices, healthcare facilities can significantly reduce readmission rates while improving patient outcomes and satisfaction.