CardioExchange Archive

CardioExchange welcome Elizabeth Bradley to discuss her recent paper, Contemporary Evidence about Hospital Strategies for Reducing 30-Day Readmissions, published in JACC. She and her colleagues used a web survey to assess the prevalence of hospital practices in quality improvement and performance monitoring, medication management, and discharge and follow-up for patients with acute MI (AMI). Of the 537 hospitals that responded, 90% reported having an objective to reduce AMI readmissions, but only half had partnered with community physicians, and on average hospitals used about half of the key practices available for reducing AMI readmission.

The evidence published this week in the Journal of the American College of Cardiology demonstrates two findings with one real-world message: we can do better. First, we found tremendous variation in what hospitals are doing to reduce readmissions for patients with heart failure and acute myocardial infarction, and, second, on average, hospitals are implementing less than half of 10 recommended practices to reduce readmissions. Surely, we can do more.

It would be helpful to have definitive studies on what practices are most effective to reduce readmissions.  Still, common sense would tell us that when only 36% of hospitals routinely follow up on test results that return after patient discharge, only 26% always send a hospital discharge summary to the primary care physician, and only 11% discharge all patients with an outpatient follow-up appointment already made, we have a problem.

None of these practices are overly expensive, but they require attention to coordination and administrative systems to support the clinical care. And while we need more evidence on their impact, these practices have the potential to make care better and more efficient.  The vast majority of hospitals reported that reducing readmissions was an organizational objective and had at least one quality improvement team working on this. The time has come to harness this enthusiasm on practical efforts that can keep discharged patients out of the hospital.

What steps is your institution taking? What is and isn’t working that you have seen?