Hospital readmission

Hospital readmission

Hospital readmission is an event whereby an invalid is readmitted into the hospital within a specified period. Therefore, re-entry is used as a benchmark for the quality of health services. Readmission rates were officially included in reimbursement decisions for the Centres for Medicare and Medicaid Services as a part of the Patient Protection and Affordable Care Act of 2010, which places fines on health facilities on higher than expected readmission rates (Jonathan, Thomas, & Arciniegas, 2018). Congestive heart failure occurs when the heart does not pump as adequately as it is expected (Kilby, Johnson, & Oepkes, 2013). Heart failure is one of the leading causes of hospitalization and readmission.

Quality Improvement Initiative

The proposed quality improvement initiative is a measure of reducing congenital heart failure patients readmission. After being discharged with a 30-day supply of medication and to have follow-ups 1-2 weeks after discharge. This will ensure that their progress is monitored and any changes are caught early, and the right steps are taken. Access to insurance and insurance details will also have to be eased to allow the pharmacists to enable pharmacists to provide the proper dosage and prevent patients from accessing the medication from other pharmacies.

Purpose of Quality Improvement Initiative

The goal of this initiative is to make the health care system more responsive to the patient’s needs. It seeks to solve some of the issues that patients go through that lead to readmission, such as inadequate access to medicine. The plan also aims to increase the efficiency of the healthcare system while also reducing the costs.

Target Population/Audience

1. Insurance Companies

Insurance companies are expected to be sharing more patient information with hospitals and other healthcare professionals. This will enable patients’ access to prescriptions to be monitored hence preventing abuse. Insurance policies will have to be formulated to cover the drugs used within 30 days and the regular hospital visits that will be introduced.

2. Patients

Patients will be expected to avail themselves of regular observations at the hospitals. They will also be encouraged to stick to the dosage provided and to notify their physicians of any changes they notice.

3. Hospital Staff

Hospital staff will be expected to ensure patient records are accurate to ensure the correct prescriptions are offered. Discharge of patients will only be carried out once the doctor has given an all-clear.

Benefits of Quality Improvement Initiative

1. Safety: the initiative seeks to promote patient safety by putting in place measures that will prevent abuse of the prescribed drugs. This will be through creating a system whereby a patient’s health records will be run at on pharmacy and notification provided to other pharmacies if the patient tries to get more drugs.
2. Increase efficiency: by reducing hospital readmissions, the hospital will have more resources to cater to other patients with similar ailments or in different wards.
3. Patient-centered: the initiative seeks to meet the needs of the patient by making the doctors and other healthcare providers more proactive to the patient’s needs. For example, one of the causes of readmission is delayed access to medicine and a physician. Therefore the plan introduces a timeframe for checkups and provides enough medication to last 30 days.
4. Reduce health costs: the adoption of a value-based reimbursement policy has placed pressure on hospitals to reduce readmissions. According to the Agency for Healthcare Research and Quality, $41.3 billion in hospital costs is accrued by patients readmitted within 30days of discharge (“Reducing preventable hospital readmissions: a way forward,” 2016).

Inter-Profesional Collaboration Required To Implement The Initiative

The plan seeks the collaboration of insurance companies, doctors, nurses, and pharmacists. Insurance companies will be required to share patients’ information with pharmacies and prevent any payments if patients try to access similar medication in different pharmacies. Nurses will be required to prepare the patient’s final medication list based on the attending doctor’s recommendations before the discharge. This list will be presented to the pharmacists who will give the medicine and ensure that the dosage can last 30 days.

Budget Justification

Hospital readmission rates cost hospitals, especially as most institutions adopt the value-based reimbursement model. Reduction in readmission rate is related to higher operating revenues as well as higher operating expenses (University of Nevada, Las Vegas, USA, Clarkson University, Schenectady, NY, USA, & Louisiana State University Health Sciences Center, New Orleans, USA, 2019). Therefore, reducing the number of invalids that return to the hospital after discharge will improve the health of patients and the hospital balance sheet.

Program Evaluation

1. Cost of Service Provision.

A regular evaluation of the costs will be carried out. This evaluation will consider the overall cost of prescriptions, hospital visits, and the cost of checkups. A drop in these costs will indicate the success of the program. The evaluation will be carried out quarterly.

2. Patient Recovery Rates:

The hospital will evaluate the number of congenital heart failure patients who recover or whose health improves as a consequence of the program. This should be carried out quarterly.

Conclusion

A health initiative to reduce hospital readmission rates is essential. High readmission rates are an indication of poor-quality health services. This hurts the company’s balance sheet in the long-term. Spending time in the hospital also affects the patient by separating them from families and their jobs.