Preventable re-admissions to hospitals have many causes.

The costs of these avoidable readmissions are now high enough that doctors, nurses and hospitals are searching for ways to reduce them.

You, the patient, or you, a friend or family member,  can help prevent a readmission to the hospital.

How?

Manage your exit from the hospital, the return to home and a prompt visit to the doctor within 3-5 days after discharge.

- You want to go home ready to follow the discharge plan. You have to plan to follow the plan because it may require you to do certain things in a certain way at certain times. These are things which are within your ability to control as best you can. What you eat. Taking medicine as directed. Following the orders for physical therapy, for example. Following the plan reduces your odds of having an unplanned readmission to the hospital.  This plan is for your benefit.

- Have a close friend or family member come up to your room at discharge and discuss the discharge plan with the nurse. Don’t ask the person picking you up to wait until a staffer wheels you to the front door. Four ears are better than two. Going home from the hospital is a big deal. Patients tire more easily than they may expect. You may not remember what you were told.

- Be sure you or your companion understands the discharge plan. If both of you do, that’s even better. Stop the  nurse if you don’t understand something. Ignore the fact that the plan may be read to you quickly-in-a-rote-way. Discharge time is busy and the nurses are moving things along as best they can. Listen! Follow along as the plan is read! Ask questions! What do they mean by “resume normal activity?” What does “feel better” mean exactly? A general sense of improvement? Or, does the patient need to be able to meet certain measures before one could say the treatment plan is successful? You need to know. Do you see any reasons why you cannot follow this plan? You must go up stairs, for instance, even if they are telling you to avoid them. Explain those to the nurse so you can get advice about what to do.

- Always fill the prescription orders you are given on the way home or shortly after. You may need to start the medications right away. Be sure you know why you are taking the medication. What is it supposed to do? What side effects should be reported to your doctor? When should you expect results? All of these questions will help you and people helping you understand how your body is responding to that medication. Do not stop a medication on your own without talking to a doctor or nurse who knows your care plan or other qualified medical professional, such as the pharmacist.

- Always make your return appointment to see a doctor at the time of discharge or as soon as you get home. You will be told to come back to a hospital clinic or to see your own physician.  Normally, these appointments are made for a time within 3-5 days after you leave the hospital.  Be sure you take your discharge plan if you are to go see your regular doctor. Your own doctor likely will not have received a copy of the hospital report unless your physician works for the hospital and has access to your records. If your first doctor visit is to be useful, take everything you received at discharge. Be sure you tell the person who makes appointments why you are coming. Your doctor may not even know you were admitted.

-Always report changes which no one mentioned. If the patient has a fever, which was not something you were told could happen, call the doctor whose name you were given. If the patient has an accident, a fall, report that. A fall may be “nothing” or “something.” We patients can’t tell the difference.

- Always keep notes for the day. On a scale of 1-10, 10 being well, how did the patient feel? Were there any problems following the treatment plan that day? What were they? How did you solve that? You will not remember what you need to report if you don’t make notes at the time. They make charts. We patients or family members make our own charts, too.

Washington Post

….“There are many reasons for (hospital)  readmissions, including high rates of medical errors and hospital-acquired infections; lack of communication between doctors who care for patients in the hospital and their regular physicians; trouble getting a prompt doctor’s appointment after discharge; missed referrals for home health care; and poor coordination and medication management during transitions from hospital to home or nursing home.

“Transitions are just so dangerous. Every time you move a patient from one setting or facility to another, you have to ask, ‘Is something going to go wrong?’ ” said Joan Teno, a geriatrician at Brown University Medical School, who has often treated her patients in nursing homes for conditions that otherwise would propel them back to the hospital. Teno said the ways nursing homes are paid mean it’s often easier for them to let the hospitals take care of sick patients.

“Experts don’t agree on how many readmissions are avoidable. Dozens of promising initiatives designed to cut down on them are underway. But many experts say sweeping changes are needed in how health care is delivered and how hospitals and doctors are paid — sensitive issues that confront Congress and the medical industry in the debate on overhauling the health system.”

Source: Washington Post, June 30, 2009, and Kaiser Health News (Collaborative report)