Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions

Moe Baloo, DC, MHA Margot Wilson, RN, MSN Yoly Ordovas – Patient Representative Providence Health Care February 27th, 2014

This project is based on recommendations from a two-day IHI conference held in Victoria in March 2013 called “Reducing Avoidable Rehospitalizations”. Special thanks to the Shared Care Committee for funding and support No disclosures to declare.

Why Study Unplanned Readmissions?

Reducing Hospital Readmissions

Unplanned hospital readmissions are prevalent, costly, and place an undue strain on patients, care providers, and the health care system1.

In Canada, 2010 data show that 30-day all-cause readmission rates are 1 in 12, or 8.5%, costing an estimated 1.8 billion dollars annually, or 11% of total hospital expenditures2.

1) J. R. Vest et al., “Determinants of Preventable Readmissions in the United States: A Systematic Review,” Implementation Science 5 (2010): p. 88.

2) Canadian Institute for Health Information, All-Cause Readmission to Acute Care and Return to the Emergency Department (Ottawa, Ont.: CIHI, 2012).

Reducing Unplanned Readmissions

3 Phases:

i) Analysis of Retrospective Unplanned Readmissions Using ‘LACE’ Scores

ii) Random Clinical Chart Reviews

iii) One-to-one Bedside Patient Interviews

Reducing Unplanned Readmissions – Phase I – LACE Scores

Patient location: Vancouver - City Centre, Downtown Eastside, Midtown, North East, South, Westside

Timeframe: Patients discharged between January 1, 2012 – December 31, 2012

Note: A LACE score of 10 equals a 12.2% expected probability of an unplanned readmission within 30-days of discharge. A LACE score of 15 equals a 26.6% likelihood of a readmission.

Readmission Group 1: # of patients= 281

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LACE SCORES

Readmission Group 1 LACE Scores

Analysis: Average = 10.18, Median = 10, Mode = 10

Population of interest # of patients = 163

LACE Score # of patients 10 50 11 30 12 38 13 18 14 9 15 8 16 2 17 3 18 2 19 3 Total 163

Phase I – Key Findings

2012 readmissions data showed the following for the adult population living in Vancouver:

o Congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and gastrointestinal disorders accounted for 22% of all 30-day readmission to the acute general medicine wards at St. Paul’s and Mount Saint Joseph’s hospitals.

Reducing Unplanned Readmissions Phase II – Chart Reviews

Key Findings:

Discharge planning was occurring, but documentation regarding what materials were handed out was not consistently recorded

The electronic health record used by clinicians and administrators did not regularly ‘flag’ readmissions

No formal process for unattached patients

Reducing Unplanned Readmissions Phase III–Bedside Patient Interviews

6 Comprehensive Interviews were conducted.

10 key questions were asked:

Do you have a family physician?

When it was time to go home, what happened?

Did you understand your follow-up plan?

Did you receive any handouts or printed information?

Did you understand what to do if you did not feel well?

Did you have a GP follow-up appointment after you left the hospital?

Did you understand all the instructions and handouts that were given to you?

What happened to make you decide to come back?

When you are discharged this time, what support would you need at home to help you remain at home to heal?

What else would you like to tell us that would improve your experience?

Reducing Unplanned Readmissions Phase III–Bedside Patient Interviews Key Findings:

Most patients had a family physician. Access to their PCP, however, was limited.

A lack of community/home support was a key factor leading to a readmission.

Discharge instructions can be overwhelming. ‘Teach-back’ techniques may be helpful.

Attention to minor details had a positive influence on a patient’s perception of care.

Frequent turnover and changes in care provider had a negative impact on perception of care

Culture, language, and contextual factors are important.

Inpatients were generally very satisfied with the quality of care received.

Engaging the patient’s family physician and/other caregivers can help reduce the likelihood of a readmission.

Reducing Unplanned Readmissions Phase III - Key Findings: In their own words:

Staff are asked about their concerns re: patient care:

Courtesy: Camille Ciarniello, PHC

Reducing Unplanned Readmissions Phase III - Key Findings:

In their own words:

Patients and their families are asked about what matters most to them

Courtesy: Camille Ciarniello, PHC

Thank You. Questions?