By E’Louise Ondash, RN
I spent a few hours in a local emergency room recently, and with only curtains dividing the cubicles, it was difficult to ignore the doctor–patient conversation happening only a few feet away.
An elderly, debilitated woman had come to the ER via ambulance and her caretaker was explaining to the doctor that the woman had been discharged from the hospital only five days before. The woman wasn’t capable of caring for herself and it had been a couple of days after discharge before her caretaker arrived at the home. Since her discharge, the patient’s condition had deteriorated significantly. The caretaker told the doctor that the patient’s breathing had become more difficult, and there also was some confusion about her multiple medications.
I couldn’t help wondering how this woman got out the hospital door without the assurance that there would be someone to care for her, and without an explicit discharge plan. I also wondered how often this scene is repeated in hospital ERs throughout the country.
Medicare doesn’t like it either.
The Centers for Medicare & Medicaid Services (CMS) spends $15 billion annually on what it calls “preventable readmissions” and is looking at ways to save money while improving patient care. One of the ways is to penalize hospitals for excess readmissions within 30 days after discharge by withholding 1 percent of payments. As of October 2012, CMS says it has saved $280 million with this policy.
Nurses know that sending patients on their way correctly requires a lot of time, attention to detail and planning – things that are nearly impossible if staffing is inadequate. A recent study confirms this.
Researchers at the University of Pennsylvania’s School of Nursing, Institute of Health Economics, and the Wharton School of Business compared more than 1,400 hospitals with high and low staffing levels. They found that higher staffing levels were associated with a better chance of avoiding the penalties associated with excessive readmission rates. The study was published in the October 2014 issue of Health Affairs.
This isn’t a surprise to nurses. We are keenly aware that discharge planning has become more complicated, especially since patients today are older and have more problems – both medical and social. There are many things to consider when trying to coordinate family, caretakers, social workers, visiting nurses, skilled nursing facilities, pharmacies, therapists and more. The bottom line is that it takes adequate staff to do the job right and avoid readmissions.
Does your hospital have adequate nurse staffing to ensure each patient receives proper discharge planning? What measures have you or your co-workers implemented to reduce readmissions? Tell us about it.