Reducing hospital readmissions and decreasing the average length of stay (ALOS) is a common goal among clinicians and caregivers. Avoidable readmissions can be expensive and are often a sign of poor communication among care professionals. Discharging patients too early can be dangerous, and the resulting readmission can be physically and emotionally costly. Meanwhile, reducing ALOS in a safe and effective manner can lower the risk of hospital-acquired conditions while saving precious time and resources.
From readmission prevention solutions to algorithm and workflow integrations, hospitals and health systems are using software and technology to identify at-risk patients early and to proactively care for those patients in an effort to reduce ALOS and decrease readmission rates. Here are four stories on how health IT solutions are being implemented to uniquely optimize the patient experience and improve overall health outcomes.
In an effort to decrease hospital readmissions, leaders at Southwest General Health Center implemented a readmission prevention and acute case management solution. The readmission prevention tool used an algorithm to add a readmission risk icon on the emergency department’s tracking board and within the workflow. This helped hospital staff prioritize patients depending on the likelihood to readmit within 30 days. Twelve months after the tool’s implementation, Southwest General had experienced a 5.52 percent decrease in its hospital-wide 30-day readmission rate.
“The fact that we made it easy for folks to see the list of high-risk patients early in the morning is really important to planning the day. If you know someone is a high-risk patient, we’re more likely to be encouraging to the patient that perhaps a skilled facility for the short-term may be the best discharge plan until they get stronger.” - Jacquie Potelicki, RN, director, Case Management and Social Services
Nurses and clinicians can have difficulty assessing at-risk patients needing immediate care without observing them at all times. In 2016, the outreach team at Kingston Hospital NHS Foundation Trust implemented a rapid response dashboard that would help clinical staff to proactively provide care through an easily comprehensible, at-a-glance view of patients.
The solution identifies patients with high National Early Warning Scores (NEWS) — a method used to quickly assess the illness of a patient based primarily on vital signs — triggering alerts to the outreach team to help assess the patient’s status and adjust care when necessary. Within six months, the length of stay for Kingston Hospital patients with a NEWS score of five or above (higher risk for deterioration) had been reduced by an average of more than six days.
“Using Rapid Response improved patient safety, it’s improved the number of patients we see, it’s improved the time in which we reach patients who need our help and it’s improved the quality of data selection.” - Critical Care Outreach Nurse Lucie Sulman
Watch more: Staff at Kingston Hospital NHS Foundation Trust use an electronic health record to save time and reduce potential risks.
Looking to improve patient outcomes, the interdisciplinary team at MU Health Care designed and implemented an electronic health record intervention project in 2016 with a goal of lowering congestive heart failure (CHF) readmissions by 5 percent. Stakeholders collaborated with cardiologists and other caregivers to develop an algorithm that compared information from the current admission and the patient’s medical history to predict if they might have CHF.
The project eventually received the MU Health Care Chief Executive Officer Award, which recognizes innovative solutions to complex problems. Their work also led to a more than 32 percent reduction in congestive heart failure readmission, more than six times their initial project goal.
“Quality improvement has been part of MU Health Care for 15 years. The most successful IT-related readmission interventions are clinician-led and IT-enabled.” - Thomas Selva, MD, chief medical information officer
In 2016, leaders at Excela Health sought a way to decrease the ALOS, and more importantly, to reduce sepsis mortality and for their patients. Using a multipronged approach over the course of several years, the Greensburg, Pennsylvania-based health system implemented the St. John Sepsis Agent algorithm and workflow integration, a sepsis management solution that looks through the patient's data to trigger alerts when they begin to display signs of sepsis. These efforts ultimately dropped Excela’s sepsis mortality rate by 20 percent while decreasing the system’s ALOS by 5 percent.
"Excela's mission is to improve the health and well-being of every life we touch. I think by having a system that crawls the chart and looks for warning or danger signs and alerts the care team that those danger signs are there allows us to improve their health and allows us to put the patients first." - Mike Widmann, clinical informatics coordinator
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