Clinical and Organizational Problem in Memorial Hospital, Jacksonville Paper Example

Introduction

High readmission rates in Memorial Hospital, Jacksonville are the problem that needs to be addressed with an evidence-based intervention. The estimated national cost or unplanned hospital readmission to the US Medicare program is $ 17 billion per year out of the total of $ 102.6 billion (Kripalani, Theobald, Anctil, & Vasilevskis, 2014). Hospital readmission rates have been suggested as a crucial indicator of quality care because they may result from actions taken or omitted during the initial hospital stay (Leppin, Gionfriddo, Kessler, Brito, Mair, Gallacher, & Ting, 2014). Readmission is considered to be clinically related to a prior admission and potentially preventable if there was a reasonable expectation that it could have been prevented. Kripalani et al. (2014) define readmission as a return hospitalization to an acute care hospital that follows a prior acute care admission within a specified time interval, called the readmission time interval.

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Readmission rates are increasingly seen as a marker of a local health care system's ability to coordinate care for patients across settings. Often, high hospital readmission rates are a sign of inadequate discharge planning and lack of community-based care. Readmissions are essential not only quality indicators but also because they are expensive, consuming a substantial share of expenditures for inpatient hospital care (Leppin et al, 2014). Therefore, readmissions can focus attention on the critical time of an acute disease when the patient is in the transition between inpatient and outpatient stages of treatment. Additionally, readmission rates can be generated from administrative data, and can thus serve to screen large numbers of records and avail a basis for comparing hospital performance. Already, it is increasingly being used in various jurisdictions across the world as a metric of the performance or quality of hospital care or treatment.

Description of Problem

Since the Patient Protection and Affordable Care Act (PPACA) became law on March 23, 2010, one of its provisions, "Hospital Readmission Reduction Program" (HRRP), which was implemented in 2013, hits hospitals where it really hurts the most: their income. Under this provision, a hospital's Medicare reimbursements are reduced when a hospital experiences excess readmission rates for various health conditions denominated by the Secretary of Health and Human Services (HHS) (Gu, Koenig, Faerberg, Steinberg, Vaz, & Wheatley, 2014). In particular, the penalties are based on a computation of the risk-standardized 30-day readmission rate for the previous three years for Medicare beneficiaries hospitalized with pneumonia, heart failure, or acute myocardial infarction (Gu et al., 2014). Hospitals with higher than expected readmission rates are penalized a percentage of their total Centers for Medicare and Medicaid Services (CMS) reimbursement, starting at 1% in year 1 of the initiative, up to 3% in year 3. Irrefutably, such high penalties to a hospital affect its costs negatively, which justifies the need for an evidence-based intervention.

Explanation of Causes

Readmission may result from incomplete treatment or poor care of the underlying issue or may reflect poor coordination of services at the time of discharge and afterward. Examples of drivers of poor transitions from the hospital to the community include lack of standard or known processes at the hospital like patient discharge, hand-over or internal workflow, and lack of information transfer, mainly across settings to the primary care provider such as delays, missing information or inaccuracies (Kripalani et al., 2014). Other causes include poor communication between provider and patient and lack of patient and family activation, which encompasses health literacy, self-management skills and tools, a locus of control, and motivation. Several studies have recorded the relationship between readmissions and quality of care. Tapper, Finkelstein, Mittleman, Piatkowski, Chang, & Lai (2016) concluded that early readmission is linked significantly to the process of inpatient care and established that patients who were readmitted were approximately 55% more likely to have had a quality of care problem.

Identification of Stakeholders

Stakeholder involvement is essential in the development of a standardized discharge checklist to reduce 30-day readmission rates at Memorial Hospital, Jacksonville. Moreover, an inclusive process for building consensus and for guiding the proposed change will garner wide stakeholder support.

External stakeholders that may have an interest in the proposed change include policymakers and health plans. The role of policymakers in the intervention will be to provide leadership and vision for a transparent, high-performing system. Health plans, by understanding the changes in readmission rates by the payer and payer type will help inform community collaborative. Internal stakeholders will include the health care provider, medical practitioners that will include physicians, nurses, and ancillary care staff, patients and families. The hospital under the leadership of the management will pre-review and validate the standardized discharge checklist. Medical practitioners will play an important role in providing and recording clinical information on the discharge checklist. Such information will inform their practice. Finally, patients and families, although they should not be engaged in solving and improving systems, they will be actively involved in creating an individualized discharge plan that will include self-management skills and tools and health literacy.

Discussion of Stakeholders

Reducing 30-day readmission rates is a policy priority seeking to improve healthcare quality. Therefore, policymakers are key stakeholders while developing and implementing a practice aimed at reducing hospital readmission rates. Moreover, policymakers are the custodians of information concerning the costs and variations related to readmissions. Thus, this information acts as evidence that justifies the need for developing the standardized discharge checklist. Therefore, policymakers have the power to influence change since the information will assist in overriding initial opposition to adopting the checklist. In addition, the information can be used to guide the design and testing of the checklist. Policymakers also have an interest in the outcomes of strategies implemented to reduce hospital readmissions such as the standardized discharge checklist. Today, health plans report readmissions at the plan levels. Understanding readmission rates help health plans inform community collaboratives. Hence, the health plans will have an interest in the development of the standardized discharge checklist, which will help them in engaging social and community support for patients. In addition, they will leverage the information on the checklist to develop community partnerships to support patients and families. Nevertheless, they do not have any power or influence over the proposed practice.

Internally, the hospital possesses interest, power, and influence over the standardized discharge checklist. First, since the hospital bears the cost of high readmission rates, it has a high interest in any intervention that can help minimize this cost. Second, the hospital, through its management has the power to review, validate, authorize, and fund the development of the standardized discharge checklist. Further, through the hospital's embracement of the checklist, it can influence its departments to embrace the standardized discharge checklist. Similarly, medical practitioners within the hospital have can positively influence on the project. Mainly, medical professionals require sufficient information to provide quality care. A standardized discharge checklist can provide aggregated patient information to inform their practices. Once they understand this, they can have a positive influence on the development and adoption of the standardized discharge checklist in the hospital. However, they do not possess any power or interest in the development of the checklist. Finally, patients and families are in need of consumer-oriented products and information that can help them avoid the high costs coupled with readmissions. Thus, patients and families can have a high interest in the standardized discharge checklist because it will be useful in the creation of individualized discharge plans that will impact them with health literacy and self-management skills and tools essential in home-based care.

Explanation of the Project

The purpose of this project is to develop a standardized discharge checklist to reduce the 30-day readmission rates at Memorial Hospital, Jacksonville.

Discharging patients from the hospital is a complicated process that is filled with challenges such as lack of information transfer, missing patient information or inaccurate records transmission to outpatient providers. Such challenges act as contributing factors to the high readmission rate at Memorial Hospital, Jacksonville. Therefore, the standardized discharge checklist will provide an effective framework for ensuring that discharge communications incorporate all key features reliably. Undeniably, this will help attempts to optimize patient discharge from the hospital, improve outcomes, and reduce avoidable readmissions.

Proposed Solution

An evidence-based standardized discharge checklist is the proposed project. The checklist will detail the steps of items that require to be completed for every day of a patient hospitalization at Memorial Hospital, Jacksonville. Notably, completing the components of the discharge checklist throughout a patient's hospitalization will ensure a successful discharge and transfer of information. Additionally, the checklist will integrate discharge planning into interprofessional care rounds happening throughout a hospital admission.

The main items of the standardized discharge checklist will be categorized into the following domains: Indication for hospitalization, primary care, medication safety, follow-up plans, and home-care referral. Other domains include communication with community collaborators or outpatient providers and patient education. Regarding hospitalization, physicians and nurses will be involved to assess the patients to establish if they still need hospitalization. Under primary care, nurses will identify the patients' primary care providers (PCP), contact and inform them of patients' admission, diagnosis and proposed discharge date, and book postdischarge PCP follow-up appointments. Under medication safety, nurses will develop patients' medication history and reconcile this to the admission's medication records. Additionally, physicians and nurses will be involved to teach patients how to use discharge medications properly.

Concerning follow-up, hospital staff will conduct a follow-up post-hospital phone call within 72 hours of discharge. A scripted checklist will be used to review high-priority items, for example, compliance with medications, signs and symptoms management, attendance at follow-up clinics, and any change or deterioration in condition. Answers to these items will determine the best cause of action such as arranging outpatient laboratory tests or booking specialty-clinic follow-up appointments. Under home care, PCPs will record any information concerning patients' existing community services or home-care agencies. The communication domain will ensure that a copy of the discharge summary plan, the medication reconciliation form, and any contact information of attending hospital physician are provided to patients, caregivers, a...