More realistically, a group might consider taking a less aggressive approach to this problem. Educating care providers and assisting these facilities with QI projects would require fewer resources and might provide a higher return on investment (ROI) for your group and hospital. Engaging these physicians, nonphysician providers, and facility administrators is key to our ability to impact this problem. Demanding quality care for our discharged patients in terms of timeliness of follow-up, adherence to care paths, and responsiveness to changes in condition should be non-negotiable and factored into our development of referral patterns.
As our population of patients continues to be more acutely ill, and the level of care provided at post-acute care facilities continues to rise, our current reality is that a majority of these patients, at any given time, meet hospital admissions criteria. Preventing readmissions requires that post-acute care providers have mechanisms in place to stop the “knee-jerk” transfer to the emergency department, rather than attempt to evaluate and treat the patient in the facility. Interact II (http://interact2.net/index.aspx) is a resource that provides tools for post-acute-care facilities to use in monitoring their own internal data around acute-care transfers. It also provides tracking tools, communication strategies, advanced-care-planning tools, and clinical pathways for limiting the number of acute-care transfers. The reality is, once these patients end up in the emergency department, they are likely to be referred to us for consideration of readmission. The best way to stop this is to stop the transfer before it happens.
Demand Better
We, as hospitalists, need to begin to leverage our own “buying power” as it relates to the care of our patients post-discharge. We can start by educating and assisting care providers on a local level to improve compliance with well-known standards of care that prevent unnecessary readmissions. We need to be prepared to wield our collective weight as a specialty to demand from our post-acute care colleagues what has been demanded of us over the last several years: quality and value. Make no mistake—hospitalists have to get outside the box.
Dr. Harrington is an SHM board member and chief medical officer of Locum Leaders in Alpharetta, Ga.
