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Rice RARE Campaign

Our pillow or yours? Rice Memorial Hospital project takes aim at avoiding readmissions (with video)

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WILLMAR — Pillows — lots of them — play a starring role in a new video by Rice Memorial Hospital about the hospital's efforts to reduce preventable readmissions.

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The message: For every night patients can spend at home in their own bed, it's one less night with a hospital pillow.

For the past two years, Rice has been part of a Minnesota Hospital Association collaborative project known as RARE, or Reducing Avoidable Readmission Events, aimed at lowering the rate at which patients end up back in the hospital after going home.

Readmissions have long been something hospitals want to avoid, but preventing them has become increasingly critical in the push for quality care, patient safety and reduced costs.

Nationally, about one in five Medicare patients is readmitted to a hospital within 30 days after discharge. The collective price tag is estimated at $17 billion annually in additional hospital care.

Moreover, hospitals are now being financially penalized if they have a higher than acceptable rate of Medicare acute-care readmissions within 30 days.

The most important reason for reducing preventable readmissions, though, is to spare patients and families from the emotional and financial burden of more time in the hospital, said Jessica Vagle, director of inpatient adult health and care management services at Rice.

"It's the right thing to do," she said.

"Preventing readmissions is just a different way of saying 'taking good care of people,'" said Dr. Fred Hund, a hospitalist at Rice.

Not all hospital readmissions can be prevented. There's in fact considerable debate over this point, as well as over which strategies are effective at reducing avoidable readmissions, Hund said. "Not a lot has been found that really works."

The consensus, however, is that hospitals can and should do more to lessen the revolving-door effect of patient readmissions.

As Rice Hospital prepared to tackle the problem, there were two key challenges, Vagle said. One was identifying which patients are at highest risk of ending up back in the hospital after going home. A second challenge was improving the transition from hospital to home, rehab facility or nursing home, a process that can be complex and often vulnerable to problems with communication and coordination of care.

Rather than a single blockbuster solution, Rice took numerous steps both large and small, from having a pharmacist review medication lists to following up with high-risk patients after they return home.

Patients are now being screened for their likelihood of readmission so those deemed at higher risk — someone with congestive heart failure, for example — can receive more attention while in the hospital. Staff have implemented "teachback" to assess how well patients and families understand what they are told.

For those entering a nursing home after leaving the hospital, the handoff now takes place between nurses. And to give primary care doctors a better picture of what happened during the patient's hospital stay and enhance follow-up care, an electronic template was created to tell the story.

One of the goals was to develop more touchpoints so that patients would be less likely to slip through the cracks, Vagle said. "Everybody really bought into that."

The process also uncovered some surprises. For example, it was initially thought that older patients living at home were at higher risk of ending up back in the hospital. But when team members looked at the data, the highest percentage of readmissions turned out to be among nursing home residents.

As a result, considerable effort was devoted to working more closely with area nursing homes to improve communication and coordination, Vagle said. "We come together and meet quarterly and talk about safe care transitions."

Another assumption, based on national patterns, was that recently hospitalized patients had lengthy wait times to get a follow-up appointment with their doctor. While this may be true for many city dwellers, "we don't have that problem as much here," Hund said. Most local patients are able to see their doctor within a week after a hospital stay, he said.

So what about that video with all the pillows? Hospital staff created it to mark the formal end of the Minnesota Hospital Association's RARE campaign last December. Along with summarizing the steps implemented at Rice, it's illustrated with dozens of photos of employees clutching pillows to clinch the point: Most patients prefer to be home with their own pillow.

During the two years of the project, Rice prevented 96.6 readmissions, which was better than the state average, Vagle said. "Those are real people and real families here in our community."

Statewide, the 83 hospitals participating in the initiative prevented 4,570 readmissions; the goal was 4,000, she said.

Look for such efforts to continue. Hund said the health care paradigm is shifting away from a case-by-case approach to a wider perspective that takes entire systems into account. "There are more and more conversations about improving systems of care," he said.

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Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at http://healthbeat.areavoices.com. Follow her on Twitter at @AnnePolta.

(320) 235-1150
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