Suggested strategies on reducing hospital readmission rate and ways of quantifying improvements

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Running Head:Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
Reducing Hospital readmission rate and how to quantify improvements achieved;
a strategy proposition paper.
By
Ahmed Otokiti, M.B.,B.S. CCRP.

2. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
Abstract
This essay tries to strategically solve the problem of Hospital readmission. Various aspects of
implementing the strategies developed, monitoring implementation while simultaneously
measuring success of strategies adopted are highlighted. How to ensure evidence based
practicethru research and systematic assessment is also shown.

3. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
Strategies on reducing Hospital readmission rate and ways to Measure
Improvement.
Introduction
The Federal Government presently loses up to 17 billion dollars to avoidable hospital
readmission of patients (Baum S. 2013).It is for this reason that the Government has decided, as
part of the implementation of the Affordable care act, to set a penalty for hospital reimbursement
for patients that are readmitted within 30 days of discharge from the hospital. Patients admitted
for Myocardial infarction (M.I), Pneumonia and congestive heart failure (CHF) who are
readmitted within 30 days shall have a 1-2% penalty reduction in reimbursement. (Baum
S.2013). For a lot of hospitals, the financial implication of this penalty fee is a huge burden
considering the fact that most hospitals are presently struggling with poor finances and imminent
closure hence why it is important to take proactive evidence based approach at solving the
problem at hand.
The main cause of readmission as identified by Robert Wood Johnson foundation in their
two part report was mainly due to communication breakdown/communication gap between
patients and the health care team in charge during the discharge process(Baum S.2013).Many of
these patients are elderly with so much medication and instructions whichcan be overwhelming
for them. Particularly, instructions about medications and wrong interpretations have been
identified. Also identified as a cause of readmission is the lack of appropriate follow up with
patients primary care physicians(PCP) due to several logisticreasons which can includes lack of
transportation and lack of primary care physician. Although some reasons are avoidable, other

4. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
reasons are beyond control for the hospitals, such issues like; lack of compliance by the patient,
patients whose conditions are highly morbid and terminal, uninsured patient who do not have
primary care physician coverage.
In other to tackle this problem, I will recommend the hospital not set up Teams as this
would only be a replication of responsibility and redundancy. The hospital’s quality assurance
review committee (QARC) should be charged with the responsibility of overseeing and
monitoring implementation of all strategies recommended to the unit and departments directly in
charge of implementing these strategies. Also another reason not to set up teams is that unequal
level of knowledge and ability among team members can result in some dominating and others
being overwhelmed and lost in the crowd (Liebler, McConnell 2007. P339).
In other to implement the strategy to achieve the goal of reducing the readmission rate,
we shall utilize the balanced scorecard as a strategic management system( Kaplan, Norton,
2006). In this system each of the unit head shall be mandated to deliver based on the four
perspectives of translating vision and strategy into action. These perspectives are Financial,
Patient satisfaction, internal business process and Potential for learning and growth. Each of
these perspective shall be guided by the need to fulfill the objectives set while periodically
measuring the achievements against a backdrop of a set target using the initiatives
recommended( Kaplan, Norton, 2006).
Strategies, Implementation, Monitoring and Quantifying Improvement.
The overall goal is to reduce hospital readmission rate by 50% in the twelve months from
day of implementation of strategy. The pharmacy unit, transportation unit and Information
Technology/communication department(I.T) heads shall be directly involved in the

5. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
implementation of the strategies .Each unit is expected to contribute as outlined here, to the
overall reduction in readmission over 12 months; Pharmacy department to contribute a 30%
reduction ,transportation and communication unit to contribute 10% respectively. This
intervention strategy shall be called Educate and Follow up initiative (EFI).
Pharmacy Department
A reconciliation, assessment and education program shall be instituted by the department
head based on the recommendation of the QARC. The pharmacy unit shall be notifiedof any
Patient with CHF,M.I and pneumonia bound for discharge. Upon this notification, the unit shall
proceed to assign a member of its staff to approach the patient comparing the patient’s
prescriptions at arrival and departure, verifying dosages and checking to see if anything is
missing, duplicated or unnecessary increased. Also educating the patient on side effects of
medication, providing details about dosage and also providing a material booklet that
summarizes the medication dosages with pictures of the medication included for easy reference.
Patients shall also be given a month supply of medication and billed for that later on follow up.
Transportation Unit
Part of the problem identified as cause of readmission is inability for patients to follow up
with their PCP post discharge due to lack of transportation. As part of the services to ensure
continuity of care, patients who live within a predetermined radius shall be offered the
transportation services from their home to the PCP in other to make it for their follow up
appointment.
Information technology and Communication Unit (I.T)

6. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
Upon notification by the Attending physician, the I.T department shall initiate an
automated phone call to the head of the pharmacy unit about the patient bound for discharge with
such information as patient’s diagnosis, length of hospital stay, and medical record number. Also
The I.T department shall proceed to create an automated phone call to every discharged patient
on the third day post discharge and 1 month post discharge. This is so as to further inquire about
any issues with their medication and should they need help.
Monitoring and Quantifying Improvement
Monthly Reportand Assessment.
Inother to ensure accountability, each of the department head shall submit a monthly report to the
QARC detailing the number of readmissions for the month, the diagnosis of patients readmitted
and the reasons for readmission. The QARC shall proceed to compute the percentage reduction
achieved by each unit compared to the target set. Also these rates of reduction shall be quantified
in dollar value as it pertains to amount saved with reduction in readmission rate. This overall
result shall be placed on bulletin boards and sent as an email to all members of the department
concerned. That way every staff understands their input goes beyond their daily job and as such
their individual duties have an overall effect on hospital sustainability.
Also the department heads would be made to understand that the result are not meant to
be for retribution or to serve as punitive measure but rather to provide an opportunity to grow
and improve (Vermillion, Terry, Davis, Owens, 2010). They can achieve this by looking thru the
result,reexamining the process and coming forth with ways of overcoming the problem upon
identifying the cause of a poor outcome. All resources requested shall be provided to the
managers in the implementation of these strategies.

7. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
Evidence Based study/Surveillance
As part of gathering evidence and data to support or stop the interventions employed. A protocol
shall be submitted to the Institutional review Board for clinical research (IRB) for approval to
undertake a clinical study. A retrospective study to compare the rate of readmission in patients
with CHF, M.I and pneumonia who had undergone the EFI as against rate of readmission in
those patients who had not undergone the EFI prior to its commencement. This study shall be
carried out aftersix months into the intervention and should there be evidence showing no
improvement, then the QARC shall be required to come up with new strategies.
Incentives
Forty percent of the end of year bonuses for the managers and head of departments involved
shall be tied to the rate of achievement of goals and objectives. This would be calculated in a
predetermined manner which is open and transparent to all.

8. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
Conclusion
Reducing Hospital readmission is one of the measures thruwhich the Government hopes to
achieve a reduction in health care spending. Hospitals need to tackle this problem
realistically,considering the penaltyfee that comes with it as hospitals are struggling with their
finances. Although setting up teams can help with implementation of strategies,they also come
with their setbacks. Most importantly, the hospital should have measures in place to aid
flexibility should there be a need to change the strategies adopted.

9. Reducing Hospital readmission rate
Ahmed Otokiti.ahmedotoks@yahoo.com;2013
References
Baum S (2013).New report asks what drives hospital readmission rates and what can be done.
Med CityNews. Retrieved on June 15, 2013from http://medcitynews.com/2013/02/new-
report-asks-what-drives-hospital-readmission-rates-and-what-can-be-done/
Kaplan, R. S., & Norton, D. P. (2006). How to Implement a New Strategy Without Disrupting
Your Organization. Harvard Business Review, 84(3), 100-109. Retrieved from
EBSCOhost.
Liebler J.G, McConnell C.R. (2007). Management principles for Health professionals. (5th
Edition).Jones & Bartlett Learning. Sudbury, MA
Vermillion, K., Terry, A., Davis, S., & Owens, K. (2010).innovations in performance
management. hfm (Healthcare Financial Management), 64(5), 98-104. Retrieved from
EBSCOhost.