Background: Kaiser Permanente Roseville Medical Center is a 340 bed facility in Northern California. Reducing readmissions has been a focus, and the current observed over expected rate is 0.77. Starting from this relatively low readmission rate, our focus has been optimizing care for patients at high risk of readmission.
A retrospective review of all patients (n=1834) admitted with sepsis over 12 months was complied, creating a database with 38 fields. Chi-squares identified three statistically significant factors: more than 3 hospital admissions during the past 12 months, pneumonia in the setting of chronic respiratory failure, and severe protein calorie malnutrition. A patient with any one of these factors had a 26 percent chance of readmission within 30 days. Furthermore, these patients were only 34 percent of sepsis patients, but made up 54 percent of all readmissions.
For the twelve month period prior to beginning the study, Clostridium Difficile related readmissions averaged 3.3 patients per month.
Reviewing these patient’s readmissions revealed cases in which patients had started anti-diarrheal medication at home, then been readmitted to the hospital with Clostridium Difficile a few days later. We hypothesized that recently hospitalized patients who promptly reported diarrhea could be tested and successfully treated for Clostridium Difficile as an outpatient, thereby reducing readmissions.
Methods: The proposed study was submitted to Kaiser Permanente Human Research Protections and determined not to meet the regulatory definition of research (45 CFR46.102). During the subsequent 10 months, the following text was added to the discharge instructions of patients at high risk for readmissions who were discharging home.
“WARNING: Some people who are treated with antibiotics develop diarrhea caused by a bacteria called Clostridium difficile. If this occurs, it needs to be treated. Untreated, it often worsens and can cause serious complications. Over the counter anti-diarrhea medications can delay treatment and worsen infection. If you develop diarrhea, please quickly contact a physician for testing and treatment.”
Results: 434 patients were discharged with the above text in their instructions. Preliminary analysis shows that 2.1 % were subsequently treated for Clostridium Difficile, and only 1% were readmitted to the hospital.
Conclusions: A simple educational message lead to successful outpatient treatment of Clostridium Difficile, thereby reducing hospital readmissions.