Avoidable 30 day Skilled Nursing Facility-To-Hospital Readmissions Deborah L. Heisey, MSN, RN, ACM-RN
Problem Statement
Proposed Solution Evidence suggests that the most effective readmission reduction interventions can reduce the rate of readmissions by up to 24% over the continuum of care if both hospitals, SNFs, and their partners work together in collaborative relationships.
Kairos Health Systems
Approximately 20-25% of patients who are discharged to skilled nursing facilities (SNFs) are readmitted to the hospital within 30 days of discharge contributing to $17.8 billion in unnecessary costs to the healthcare system.
Beginning 2018, the U.S. Department of Health and Human Services set a goal to link 90% of all traditional Medicare payments to quality or value through the Hospital Value-based Purchasing Program and the Hospital Readmission Reduction Program
SNF Preferred Provider Network (PPN)
Penn Medicine/LG Health
Background
Perspectives on root cause analysis for readmission differ between hospitals and SNFs in the current literature. In a prospective cohort study, 30% of readmissions were rated as potentially avoidable from the perspective of the hospital as opposed to 13.3% from the perspective of the SNF staff.
Patients who are readmitted to the hospital during their short term rehab experience significant functional impairment leading to a vicious cycle of recurrent exacerbations of chronic illness and functional decline.
Multi-component interventions that span both inpatient and post acute care were found to be more likely to sustain success in reduction of readmission than single component interventions.
Discussion and Conclusion Use of INTERACT Quality Improvement Tool for Review of Acute Care Transfers -Monthly reporting of readmissions
Interventions To Reduce Acute Care Transfers INTERACT is a quality improvement program designed for post-acute care that was found to reduce avoidable 30 day skilled nursing facility to hospital readmissions by up to 24% as opposed to 8.7% when Project ReEngineering Discharge (RED) was implemented in similar facilities. INTERACT was found as the most rigorously studied among the two multi-component quality improvement programs.
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30 day readmissions were evaluated as potentially avoidable, or unavoidable, with a structured medical record review process similar to a standardized instrument found in evidence-based literature
14.0%
Readmission Rate 12.8%
12.0% 10.0% 8.0% 6.0%
Projected savings to Medicare in a 100-bed SNF were approximately $125,000 per year.
4.0% 2.0% 0.0%
Implementation Nine SNFs were selected within the Preferred Provider Network that demonstrated facility readiness, a high level of leadership engagement among the medical directors, strong nursing leadership, and excellent skilled facility quality measures.
INTERACT was found to be a reliable intervention to reduce avoidable 30 day skilled nursing facility to hospital readmissions.
7.30%