Home From The Editor The next frontier in preventing readmissions?

The next frontier in preventing readmissions?

February 2014

Published in the February 2014 issue of Today’s Hospitalist

HOSPITALISTS ARE BEING ASKED to focus an increasing amount of attention on preventing unnecessary readmissions. Now that Medicare is financially punishing hospitals that have high rates of bouncebacks, readmission prevention has become big business.

While hospitals are looking for the silver bullet to reduce unnecessary readmissions, one strategy may be right under everyone’s nose: doing a better job for patients who have experienced or are at risk for delirium. As our cover story points out, delirium affects nearly one-quarter of inpatients, with experts saying the condition may be significantly under-diagnosed, especially in hypoactive patients. Because delirium can persist for weeks or months after discharge, those individuals are at higher risk for a host of bad outcomes “and are more likely to bounce back.

The solution, according to the sources in our article, is to create a solid discharge plan for these patients. A big part of that strategy needs to focus on eliminating unnecessary medications that may exacerbate the patient’s delirium. Keep the delirium at bay, the thinking goes, and the patient will be better able to comply with medication regimens and general discharge instructions “and caretakers will be better able to care for the patient.

It may sound like these recommendations fall under the categories of good patient care and common sense, but there’s clearly room for improvement.

A study published last year in the New England Journal of Medicine grabbed headlines by using the term “post-hospital syndrome” to explain the iatrogenic effects of hospitalization. It turns out that being in the hospital may overwhelm just about everyone, due to chronic sleep deprivation, lousy nutrition and patients’ fears related to being ill. Patients who actually cross the line into becoming delirious pose even bigger problems that need to be addressed (and, hopefully, ameliorated) at discharge.

So what is your hospital doing to address delirium at discharge “and to prevent those readmissions?

edoyleEdward Doyle
Editor & Publisher
edoyle@todayshospitalist.com