The Admitting Process Role in 30-Day Readmissions

As part of an effort to reduce 30-day readmissions, two questions must be addressed when a patient enters the ED. The first is whether the patient had an inpatient admission within the last 30 days and the second is whether the patient is a risk of becoming a readmission in the next 30 days after discharge. This information should be available to the admitting ED provider.

As outlined above, the type of hospitalization that is appropriate for readmission patients must also be considered. Observation patients are not considered readmissions. However, even these patients may be at risk of becoming a readmission upon discharge. The use of a PCAT model is one method to attempt early recognition of a 30-day readmission or a patient at risk for readmission, with provider, nursing, pharmacists, and support all involved at this early stage. The team-based care delivery model provides focus all the way through to the patient discharge to make sure proper followup and an ability to address other issues such as medications or transportation.

Standard practice for patient admissions to a hospital unit can easily be checklist-based system:

  • (1) Anticipated discharge location—home-NH-Rehab, etc.
  • (2) Transportation needs—family, friends, taxi, stretcher, etc.
  • (3) Medication needs—insurance, available financial resources, etc.
  • (4) Anticipated home needs—equipment, oxygen, PT, home care
  • (5) Follow-up needs—PCP availability, sub-specialty needs, etc.

Asking these questions at the time of admission, will help providers address potential readmission issues prior to their discharge. These components are the starting point. At the time of discharge, additional information will be required. Several variations of this concept are in use today [24].

Patients who have returned to the hospital within 30 days obviously need to be identified and properly dispositioned. But the identification of patients at risk for readmission is more complex. Certain disease processes have been identified as potentially high readmission risk areas:

  • • CHF
  • • COPD
  • • Pneumonia
  • • Post-sepsis
  • • Post-acute MI
  • • Cancer undergoing treatment

Patients who present to the Emergency Department with these diagnoses should be managed in the same fashion as a known 30-day readmission. Once a patient has been identified as either a 30-day readmission or a high risk for readmission and requires inpatient hospitalization, they are transferred to an inpatient bed on a hospital floor, where further processes and considerations must be in place.

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