Readmission to the hospital shortly after discharge is common and costly. Reducing preventable hospital readmissions would improve health care quality and reduce costs. New models for providing care during the crucial first few weeks after hospital discharge, when patients are most vulnerable to readmission, are needed. Hospitalist‐run postdischarge clinics can provide continuity of care with prior inpatient care providers, enhance access to early postdischarge follow‐up, affirm patient education that was started in the inpatient setting, and not require sophisticated information transfer i to be effective. Such clinics may offer benefits in many health care systems struggling to reduce hospital readmissions.
To improve care transitions in recently discharged patients by providing access to a clinic created expressly for these patients, staffed by hospitalists.
The Denver VA Medical Center has more than 7 years of experience with a hospitalist‐run postdischarge clinic. Recently discharged medical patients are scheduled 2 afternoons per week. They are initially seen by the house staff who cared for them during their inpatient stay, then staffed with a rotating hospitalist attending who may or may not have been involved with the patient's care as an inpatient. There are no prespecified criteria for who is seen in the postdischarge clinic, and patients can be seen more than once. The clinic has the same capabilities as a primary care clinic for obtaining ancillary data, such as laboratory studies or imaging. The 538 patients seen in the clinic since January 2005 averaged 67 years of age, had multiple comorbidities (Elixhauser score of 0.8, 10 discharge medications on average), and had an average hospital length of stay of 3.75 days. Eighteen percent had a prior hospital admission in the past year. Thirty days after discharge, 13% had been readmitted, with a 1.1% mortality rate. The average time to postdischarge clinic visit was 5 days.
The postdischarge clinic at the Denver VA has a lower 30‐day readmission rate, mortality rate, and length of stay than the national VA average (15% readmission rate, 4.8% mortality rate, 4 days) and national Medicare reports (21.5% readmission rate). A hospitalist‐run postdischarge clinic may decrease length of stay if discharging physicians know they have access to early postdischarge care, while identifying problems and providing continuity early in the postdischarge course to reduce readmissions. The clinic may also be an educational experience for trainees to see a full cycle of illness and to experience failures in transitional care firsthand. More research is needed to determine which patients and care settings outside the VA may benefit most from establishing a postdischarge clinic.