En español | In air travel, frequent fliers get a lot of perks. Not in the hospital. Patients who bounce in and out of the hospital are also called frequent fliers, and this happens to more people than you might think.
For Medicare patients, one in five is rehospitalized within 30 days, one in three within three months, according to research by Stephen Jencks, M.D., published in 2009 in the New England Journal of Medicine.
Readmission is less common for the under-65 population, but it's still a problem.
Many readmissions, which cost the health care system billions, are preventable. Researchers are working on several approaches — some wrapped into the new health care law — to reduce unnecessary trips to the ER and the hospital. While the experts try to improve coordination among hospitals, nursing homes and doctors' offices, they also have tips for families to reduce the risk — and the stress.
Make yourself heard — then say it again
Patients believe all their doctors — in the hospital and in the community, primary care and specialists, day and night shifts — communicate. That's not always true.
"Patients and families need to recognize that they, to a much greater extent than they might wish, are the glue holding this process together," says Jencks.
Eric Coleman, M.D., a care transitions expert at the University of Colorado Medical School, agrees: "Don't confuse information with communication."
- Your regular doctor might not know you are in the hospital, let alone have time to visit you. If the hospital hasn't called, you or a family member should. Start planning your follow-up visit and tests. Half of the Medicare patients readmitted within a month hadn't seen a doctor after leaving the hospital, according to the study by Jencks.
- "Teach-back" means hearing instructions and then repeating them back to hospital caregivers over a few days. This method helps people remember instructions about medicines, treatment and care. If the hospital doesn't do this, politely say, "Do I have this right?" and "Please explain this again."
Nip medication mix-ups in the bud
- Be aware that medication problems are a prime cause of readmissions. People arrive at the hospital with one set of drugs, leave with another, creating room for mix-ups, duplication, confusion and harmful interaction.
- Doctors need to know all the drugs a patient is taking — prescription and over the counter, including vitamins and supplements. A friend or relative might want to go to the patient's home and check medicine cabinets, bedside tables, kitchen counters, purses, drawers, shoe boxes, the fridge.
- Confusion can occur in many ways. One example: A patient can get "a statin" in the hospital and not realize it's similar to the "heart pill" at home. Ditto for blood pressure medicines, antacids and other drugs. Taking both can be dangerous.
- Get clear written and oral instructions about what to take, what not to take, and when and how to take medicines. When doctors contradict one another, insist on clarification. "The most important thing is fine-tuning that medication list. And I don't care if you are Einstein, you need another person with you to ask questions and make sure you understand," says Carol Levine, director of the Families and Health Care Project at the United Hospital Fund in New York.
Know whom to call if you don't feel well
- Know the danger signs for your condition and have a plan so that you don't overreact — or underreact. (Sometimes you do need to call 911.) Ask, how can I tell whether there is a real problem? How can I tell whether I am going downhill?
- Know whom to call, by day and on nights or weekends. "If things seem to be going badly, who do I call? If the answer is 'the ER,' you are already three-quarters of the way to being readmitted," says Stephen Jencks, M.D.
- Will you need help with transportation to your doctor appointments?
- Ask what services are available in your community after your discharge. A home visit from a nurse? Telephone monitoring? Classes? These are becoming more common.
Want to know more?
- The United Hospital Fund's guides on the website Next Step in Care can be tailored for your family. Hospital to home? Hospital to rehab? Rehab to home? They cover home care, ER visits, record keeping, etc.
- The University of California School of Medicine's Care Transitions Program has online tips for patients and families on care after the hospital.
- The Agency for Health Research and Quality's "Going Home Guide" (PDF) focuses on medication and follow-up appointments.
- Medicare's hospital discharge checklist (PDF) has pointers on lining up help with cooking, bathing and shopping.
- "Caring Connections." Talking about whether and how often we want to be in the hospital as we near the end of life is hard on families — but not talking about it is harder. This guide can help.
Joanne Kenen is a Washington writer who specializes in health policy issues.