How can hospital arrivals be prevented?

Strategies to Prevent Hospital Admissions

The most effective approach to prevent hospital admissions is implementing structured discharge planning tailored to individual patients, timely follow-up care, and comprehensive transitional care models that address both medical and social determinants of health. 1

Key Prevention Strategies

Improving Transitions of Care

• Implement structured discharge plans tailored to individual patients, including clear medication reconciliation, pending tests follow-up, and scheduled outpatient appointments 1
• Provide patients with appropriate durable medical equipment, medications, and supplies at discharge to avoid dangerous gaps in care 1
• Schedule timely outpatient follow-up appointments prior to discharge, as this significantly increases the likelihood that patients will attend 1
• Ensure clear communication with outpatient providers through prompt transmission of discharge summaries 1

Targeting High-Risk Populations

• Focus on patients with diabetes, who have hospital readmission rates between 14-20%, nearly twice that of patients without diabetes 1
• Identify patients with heart failure for targeted interventions, as they represent a significant portion of preventable readmissions 1
• Monitor insulin adjustments for patients admitted with A1C >9%, as this can reduce readmission risk 1
• Implement collaborative person-centered medical homes for patients with diabetic kidney disease to decrease risk-adjusted readmission rates 1

Addressing Social Determinants of Health

• Consider socioeconomic factors in readmission prevention strategies, as lower socioeconomic and educational status are associated with higher readmission rates 1
• Schedule home health visits for vulnerable patients, which has been shown to reduce readmission rates 1
• Implement transitional care models that address both medical and social needs 1
• Recognize that male sex, longer prior hospitalization duration, and number of previous hospitalizations are risk factors for readmission 1

Reducing Hospital Utilization Through Alternative Care Models

• Utilize telemedicine or "hospital at home" programs to meet medical needs without requiring hospital visits 1
• Compartmentalize care for high-risk patients to minimize exposure to hospital-acquired infections 1
• Develop protocols for structured patient care and computerized physician order entry to ensure consistent, high-quality care 1
• Implement virtual glucose management services for patients with diabetes to improve glycemic outcomes without hospitalization 1

System-Level Interventions

• Develop hospital-based interventions that improve desired outcome metrics such as readmission rates 1
• Implement robust qualitative and implementation research regarding structures and processes of care within pragmatic trials 1
• Focus on prevention of initial hospitalizations through accountable care organizations 1
• Utilize health information technologies to enhance nurses' assessment of patient problems and planning care strategies 1

Common Pitfalls and How to Avoid Them

• Incomplete Discharge Planning: Ensure discharge plans include medication reconciliation, follow-up appointments, and clear communication with outpatient providers 1
• Inadequate Risk Assessment: Identify high-risk patients early using factors such as previous hospitalizations, comorbidities, and socioeconomic status 1
• Poor Medication Management: Cross-check medications at discharge to ensure no chronic medications were stopped and review new prescriptions with patients 1
• Failure to Address Social Needs: Consider social determinants of health and provide appropriate support services 1
• Delayed Follow-up Care: Schedule follow-up appointments before discharge and ensure timely outpatient care 1
• Overreliance on Technology: Ensure that health information technology solutions fit with complex nursing workflows to avoid workarounds and unintended consequences 1

The Hospital Readmissions Reduction Program (HRRP) has demonstrated that financial incentives can drive improvements in care transitions and reduce readmissions. Raw all-cause hospital readmissions for target conditions within Medicare Fee-For-Service decreased from 17.9% to 15.8% between 2008 and 2016, with similar decreases in risk-standardized readmission rates 1. However, it's important to note that some of these improvements may reflect changes in coding and patient management rather than quality improvement alone 1.