The hospital may be the best place to regain your health. However, once you’re better, you probably don’t want to return anytime soon. Hospital readmissions are expensive and potentially harmful to your health. Here’s what you can do to avoid them.
Hospital readmissions are an increasingly expensive problem. About 20 percent of hospital patients in the United States are re-hospitalized within 30 days of discharge. Among Medicare patients, 76 percent of the readmissions within 30 days of discharge are avoidable. Unnecessary readmissions contribute to waste in our health care system.
Returning to the hospital exposes you to potentially harmful infections, medical errors and other complications such as overall deconditioning of your body. Readmissions can also reduce your resources – both financial and emotional.
A patient’s successful transition to home, or to a nursing home or rehabilitation facility, occurs outside the hospital but it begins in the hospital. It’s called transitional care and, when used effectively, it can reduce hospital readmissions within 30 days of discharge by up to 48 percent.
Before you leave the hospital be sure you do the following:
- Talk to the hospital’s discharge planner well before you are due to be released. Include a family member or your caregiver in this discussion.
- Talk to your doctors and nurses about your health condition and what you can do to get better. Ask about problems, symptoms or side effects to watch for and what to do if they occur, once you’re home again. Get a name and phone number to call if you have concerns.
- Get a written plan of care and be sure you understand every part of it, as well as verbal instructions for your care. If not, ask questions until you and your caregiver are comfortable explaining what you need to do to stay healthy at home. Patients (and/or their caregivers) who are not involved in developing the care plan, or do not understand what to do, are 34 percent more likely to be readmitted to the hospital. Have a phone number to call if you have questions. Because you may be heavily medicated or confused when you are discharged, written instructions are very important. Discharge instructions should include a summary of your current health status. Bring this summary and your drug list to your follow-up appointments. Your pharmacist can also help reconcile any medication changes that were made during the hospital stay.
- Decide who will provide help with basic self-care or more intensive care (such as a feeding tube, injections or wound care) at home. It could be a home health agency, visiting nurse or family caregiver. Get the name and phone number of the agency or individual you’ll be using. Be sure you understand exactly what services they will provide, the cost and how often they will visit you at home.
- Talk with the facility, such as a rehab center or nursing home, that will be handling the next phase of your care if you are not going home.
- Understand your medications – which medications will change, be stopped or new meds that will be added. Before you go to the hospital, make a list of all medications and over-the-counter medications, vitamins and supplements you use. Include the name, what it is for, strength, dosage and schedule. (If it’s an emergency, just put all your meds and supplements in a bag and take it to the hospital.) Be sure you and your caregiver understand what each medication does, how much to take and when and possible side effects. Get a phone number for the hospital pharmacy for medication questions.
- Ask if you will need medical equipment such as a walker or oxygen after you leave the hospital. Be sure you have a written order or necessary documentation for any equipment before leaving the hospital. You will also need the equipment supplier’s name and phone number. Be sure you and a caregiver know how to use each piece of equipment, how long you will need it and what to do if problems develop.
- Ask if you are ready to do the following activities: bathe, dress, use the toilet, or climb stairs; cook, shop, clean the house, or pay bills; get to doctor appointments and pick up prescription drugs. If you cannot do these things, be sure you know who will be doing them for you and their phone number.
- Learn how to perform tasks that require special skills such as wound care or giving a shot. Ask hospital staff to watch you perform these skills so you will feel confident doing them at home. Get written instructions for each procedure to take home with you.
- Speak with a hospital social worker if you’re worried about how you or your family are coping with your illness and recovery. Get information about support groups and other community resources, if needed.
- Talk with your health insurance plan about what your insurance will cover and about how much you will have to pay. Ask about ways to get help with your costs if they will be a burden for you. A hospital social worker may also be able to help with insurance matters.
- Get an appointment with your primary doctor before you leave the hospital and do not miss this appointment. This is a crucial part of avoiding readmission to the hospital. In fact, patients who saw their regular doctor for a follow-up appointment within seven days of hospital discharge, were much less likely to be readmitted.
- Be sure your hospital doctor sends a discharge summary report about your hospital stay to the doctor where you’ll be having your follow-up visit within seven days.
- Keep a calendar with your care plan to track follow-up appointments, lab appointments and other doctors’ appointments.
- Sign up for the “patient portal,” if available from your hospital. Using it provides a quick way to get answers from the exact person or department you need to contact. Patient portals are secure computer websites that give you convenient, private, 24-hour to health information and health professionals anywhere there’s an internet connection.
- Get the prescriptions and any special diet instructions to the caregiver before your discharge. The caregiver can purchase needed items before discharge and avoid extra trips after you’re home.
- If you don’t have a caregiver but will need care you may not be able to manage alone after discharge, consider a home health or other home care program, even if for a few days. It can make a huge difference in how quickly and completely you recover.
- If you think you’re being discharged too soon, talk with your doctor. You have the right to ask for a review of the discharge decision by an independent reviewer.
- Consider using telemonitoring technology when you return home, if available from your hospital. This can be very helpful if you are seriously ill or have a life-threatening chronic condition. In a New Jersey study, congestive heart failure patients were equipped with a small transmitter that sent their readings to health care professionals. Anytime the transmitter detected a risk (high blood pressure or weight gain, for example), a medical professional was alerted to check on the patient, thus avoiding an expensive hospital visit.
Ensure your speedy and complete recovery after being in a hospital by talking with everyone involved with your care, seeing your regular doctor within a week of discharge, understanding what medications will change and having someone available to help you at home.
Photo by sturti, E+Collection
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