Physicians disconnected on hospital discharge of heart patients

Hospitals are still at the preliminary stage of adhering to 10 recommended practices aimed at reducing readmissions for patients admitted with heart failure or acute myocardial infarction (AMI). A new study conducted by The Commonwealth Fund concluded that less than 3 percent of hospitals use all 10 practices.

“Contemporary Evidence about Hospital Strategies for Reducing 30-Day Readmissions,” published this month in the Journal of the American College of Cardiology, surveyed more than 500 hospitals to determine their use of 10 practices that are associated with lower readmission rates.

Use of the 10 practices recommended varied widely among the hospitals surveyed, with hospitals implementing, on average, 4.8 of the 10 practices.

“A majority of hospitals participating in a national campaign to reduce preventable hospital readmissions have taken preliminary steps to avoid readmissions of patients with heart failure or acute myocardial infarction, including monitoring readmission rates,” the study authors noted. “But many important practices, such as alerting outpatient physicians of a patient’s discharge within 48 hours, are only infrequently in place.”

The study noted that the inconsistent use of the recommended practices could be attributed to a number of factors including lack of resources and limited availability of staff time to devote to the project.

“It may also reflect the complexity of coordinating efforts among physicians, pharmacists, nurses and many of the ancillary staff to achieve a smooth discharge,” the authors wrote. “Standardizing systems for reducing readmissions may address some of these challenges.”

Other findings of the study include:

  • Using quality improvement teams to enhance care for AMI patients and monitoring 30-day readmission rates was relatively common (87 percent and 94.6 percent, respectively), as was partnering with home care agencies and nursing homes to reduce readmissions (67.9 percent). However, fewer than half of the hospitals coordinated with community physicians or physician groups (49.3 percent) and other hospitals (23.5 percent) to reduce readmissions.
  • There was a high degree of variation in the use of medication management techniques, suggesting that medication reconciliation practices are not standardized at most hospitals. In nearly half of the hospitals, a pharmacist or pharmacy technician was never involved in obtaining medication history (46.4 percent). Educating patients or their caregivers about medications was more common (77.2 percent).
  • While 65.3 percent of hospitals provided patients or their caregivers with some type of emergency plan should symptoms change, several recommended discharge and follow-up practices were not implemented by a majority of hospitals. Those included having a process in place to alert outpatient physicians within 48 hours of a patient’s discharge (37.3 percent) and assigning someone to follow up on test results after a patient was discharged (35.8 percent).