NJ makes progress on cutting rate of hospital readmissions

An infection, bedsores or a blood clot that travels to the lungs are all conditions that can complicate healing, prolong a hospital stay or send a patient back to the hospital too soon.

Avoidable complications and preventable readmission cost the health system extra dollars.

A new report shows that certain “hospital-acquired” illnesses now happen less often in New Jersey medical centers.

Aline Holmes, senior vice president of clinical affairs at the New Jersey Hospital Association, led a three-year, federally funded initiative to make hospital care safer and, ultimately, to drive down the number of patients who bounce back to the hospital.

At baseline, the 30-day readmission rate for the network hospitals was 21.4 percent; three years later, it had fallen to 19.8 percent, according to the report. Avoiding return trips to the hospital saved about $84 million, according to the hospital association analysis.

Holmes says patient-safety teams attended webinars and in-person meetings to share ideas.

Before the initiative began, New Jersey was already working to reduce the number of early, elective deliveries. Those babies have a higher risk for a return visit to the newborn intensive care unit, Holmes said.

At the start of the patient safety program, about 8 percent of babies in New Jersey hospitals were born after an elective delivery before week 39. By the end of 2014, the rate was down to nearly 1 percent, Holmes said.

The federal government realized it was spending a lot of money on babies born prior to the 39th week of pregnancy, she said.

“The brain really develops significantly in the last three weeks or so of pregnancy, it almost doubles in size during that period of time. And it needs to double in size while all the baby has to do is be quiet and lie in the mother’s uterus,” Holmes said.

“If you bring the baby out early, the baby’s brain is growing, but that growing happens while the baby is having to figure out things like breathing and eating,” she said. “Pediatricians will say that the development isn’t as smooth when the baby is forced to come out of the mother early.”

New Jersey invested to get that message out to pregnant women, and reinforce it with health workers.

Monitoring hospital-acquired conditions

Urinary tract infections are one of the most common illnesses that patients pick up after they’re admitted to the hospital. During an operation or when they arrive in the emergency room, patients often need a thin tube inserted into the bladder to monitor fluids. But the longer that catheter stays in place, the greater the risk that germs will enter the body and cause trouble.

Garden State hospitals established systems so catheters are removed as soon as medically possible.

“Ask the physician every single day, ‘Does this patient need that catheter?’ Having protocols where nurses can discontinue that catheter on the second post-operative day unless the physician writes an order to the contrary,” Holmes said.

Last week, the federal government awarded Holmes’ group $1.8 million to continue its work for another year.

Patient-safety experts will add sepsis to the list of hospital-acquired conditions they are monitoring and working to reduce.

“Patients get an overwhelming infection, and the toxins that the bacteria are releasing in the body cause multiple organ failures, so their kidneys may stop, what we call severe sepsis or septic shock,” Holmes said.

In the coming year, the network will also use data on race and ethnicity to better analyze the state’s readmission rates.

The federal government is paying for many different programs to avoid preventable readmissions.

Smoothing the transition from hospital to home

Across the state line, the Philadelphia Corporation for Aging, Einstein Medical Center and Temple University Hospital formed the North Philadelphia Safety Net Partnership.

The program helps seniors with all the complicated things necessary for a smooth transition from hospital to home, said Kathy Mahan, director of care management at Einstein Healthcare Network.

“We meet patients at the bedside,” Mahan said.

“Bridge care coordinators” usually begin by speaking with people about their illnesses, and often need to do basic education, she said.

The hospital industry is developing best practices for the things that should be accomplished before a patient is discharged.

A confirmed follow-up visit with a primary care physician should be on the calendar to happen within seven to 10 days. Patients should know what medicines they need to take and where to get those prescriptions filled. They should also understand their doctor’s orders about diet and self-care.

After discharge, someone from the Philadelphia Corporation for Aging follows the patient’s progress for 30 days with check-in phone calls or visits.

“We confirm with them a contact number, if we can get a second number that’s even better, so we can be sure to get in touch with the patient after,” Mahan said.

The partnership is entering its fourth year. About 4,900 patients have been enrolled. The readmission rate for that group is nearly 16 percent now; it was about 26 percent at the beginning.

“We did not have a solid infrastructure to reconnect patients back out to community resources,” said Steve Carson, vice president for clinical integration in the Temple Center for Population Health. He works to improve the quality of care.

Now, Temple trains laypeople called community health workers to support hospital patients when they are discharged.

“That person works in the weeds with the patient,” said Jeffery Slocum, manager of care transitions at Temple University Hospital. He helps high-risk, high-cost patients transition from the medical center.

“Patients have a lot of social needs,” Slocum said. Transportation is a big one.

“Even though we are in a very large city, and have buses and train and subways all around us, a lot of folks just did not understand their transportation benefit or how to get from an appointment back to home,” he said.