Background: The United States sees over 35 million hospital discharges a year with a 20% readmission rate. Unplanned readmissions amount to 20 billion dollars annually. Efforts to prevent readmissions impact patient’s overall morbidity/mortality and alleviate the financial burden on health care systems. To that effect, the United States health care reform, under the Affordable Care Act’s Hospital Readmission and Reduction Program, has fined penalties for excess Medicare readmissions. Since, readmission rates have declined as a result of several initiatives targeting transition of care (TOC), follow-up appointments, post-discharge phone calls, nurse navigation, etc. Though these interventions have proved fruitful, none focus on Emergency Department (ED) revisits by means of Hospital Medicine (HM) and Emergency Medicine (EM) collaboration
Purpose: To prevent avoidable readmissions by implementing a Trigger Program in which a multidisciplinary team, led by a Hospitalist group in collaboration with the ED providers screen ED revisits discharged from the Department of Medicine (DOM) within 30 days
Description: In collaboration with the Chief Information Officer, the Hospitalist Division at Lenox Hill Hospital (LHH) created an automated and real-time “ED Revisit Alert” sent to the Hospitalist group, the ED’s case managers and social workers and their leadership. Every patient seen in our ED within 30 days of being discharged from the DOM triggered an alert that conveyed the following information: patient’s name and insurance, medical record number, time of ED visit, discharge date, name of previous admission attending and current complaint. In response to the alert, our Hospitalist group assessed the patient within 90 minutes and in close collaboration with the ED provider, discussed the case and determined a safe disposition plan. If the decision was made to discharge the patient, physical therapy, case manager and social worker, aided in the TOC process. Other consultants (i.e:Palliative Care) got involved when needed. The Hospitalist group monitored both Hospitalist and non-Hospitalist alerts, working closely with the private attendings. We then retrospectively performed a chart review of all ED Triggers and analyzed: initial discharge diagnoses, revisit complaints, comorbidities, index disposition, follow-up, preventable vs non preventable readmission, and length of stayThe ED Trigger Program began on September 1st 2017. We compared two groups: the baseline group (01/01/17–08/31/17) and the intervention group (09/01/17–10/31/2018). We found a 21.3% readmission reduction for 30-day Medicare readmissions for the DOM and a 26.2% readmission reduction for the Hospitalist group. We also compared the readmission rates for the DOM for all insurances from Oct 2017 YTD to Oct 2018 YTD and found a 28% readmission reduction. This retrospective chart review helped identify other variables that could have an impact on readmissions and which prompted new Hospitalist initiatives
Conclusions: The ED Trigger Program at Lenox Hill Hospital relies on a strong and timely collaboration between HM/EM and has proven efficient and valuable at readmission rate reduction. Given the opportunity for improved morbidity/mortality as well as decrease health care utilization and cost, it will be worthwhile to implement this initiative across other health care system