Check Out of the Hospital—and Stay Out

A Savannah woman was hospitalized last winter after blood poisoning in her thumb turned into a staph infection. She lost part of her thumb, and it took seven weeks for antibiotics to beat the infection.

The 82-year-old returned to assisted living without any rehabilitation to build up her strength after lying in a hospital bed all those weeks, according to her daughter, Ruth Smoak. In her first week back in assisted living, her mother fell seven times and twice went to the emergency room of the hospital that discharged her, Smoak said. Then her mother went to the hospital again with acute renal failure—less than a month after the first discharge.

"All they did was discharge a weak lady who could not go back and pick up where she left off,'' said Smoak, whose mother did not want to be identified.
   
The national rate for Medicare readmissions within 30 days is 18 percent, according to the Commonwealth Fund. In Georgia, it is 17.7 percent.
   
A 2009 study in the New England Journal of Medicine found between 20 percent and 40 percent of Medicare hospital readmissions are preventable. The lead author of the study, Stephen Jencks, M.D., said the estimated cost of preventable re-hospitalizations nationwide is $17 billion a year.
   
Readmission often stems from a communication breakdown between hospitals and patients or their caregivers. "The loneliest moment in the world for a lot of patients and families was the moment they went out the door of that hospital,'' Jencks said. By reducing readmissions, Jencks added, "you're going to probably save lives and are going to save a lot of money."

Added Ken Mitchell, state director of AARP Georgia, "The system is not working."

To reduce readmissions, Medicare financed 14 pilot programs around the country. Through the Georgia Medical Care Foundation, the Care Transitions Initiative aims to educate the patient and caregiver in how to take medications correctly, identify potential problems after discharge, and find community-based services. Pilots are under way in Gwinnett, Rockdale and Newton counties.

Can it work? It did at Atlanta's Piedmont Hospital, where an earlier effort cut readmissions to 10.6 percent among Medicare patients.

The new health care reform law will impose financial penalties on hospitals with excessive readmissions for medical conditions such as heart attacks and pneumonia.

Currently, hospitals gain financially from return trips because they get additional reimbursement for a second stay, said Anne-Marie Audet, M.D., a Commonwealth Fund vice president. A preventable readmission "is a safety issue—it's an error," she said.

Medication problems drive many readmissions. Patients often don't understand how to take their prescriptions, including new drugs received in the hospital. Another key factor is whether patients have an adequate support system at home.

Lois Ricci, a geriatric nurse practitioner in Atlanta, said many patients "are not getting enough information, or they're not understanding that information.'' Hospital discharge is often treated as a perfunctory task, and staff do not take time to make sure the patient or family members understand medical instructions, she said.

Patients who don't see a physician after they're discharged often wind up back in the hospital, AARP's Mitchell said. That's the case for about half of the Medicare patients who are readmitted within 30 days, he said.

Patients should be able to repeat medical instructions before discharge, and they should go home with a personal health record listing medications, medical history and phone numbers they can call day or night as well as numbers for doctors and other health care providers. If questions arise for home services or nursing care, you can get assistance from the Area Agency on Aging at 1-866-552-4464.
   
Andy Miller is a freelance writer based in Atlanta.