Patient safety events and postoperative complications are often the result of poor-quality care, and lead to unplanned readmissions. Improving the coordination of care, better discharge planning, and early physician follow-up can lower readmission rates.
Starting in 2013 as a permanent component of Medicare’s inpatient hospital payment system (IPPS), and as originally established by a provision in the Affordable Care Act (ACA), the Hospital Readmissions Reduction Program (HRRP) requires Medicare to reduce payments to non-exempt acute care hospitals for readmissions occurring after initial hospitalizations for select conditions including heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), elective hip or knee replacement, and coronary artery bypass graft (CABG).
According to the Centers for Medicare and Medicaid Services (CMS) all unplanned readmissions are considered an outcome, regardless of cause. From a patient perspective, an unplanned readmission for any cause is an adverse event1. Preventing avoidable readmissions has the potential to profoundly improve both the quality of life for patients and the financial wellbeing of health care systems.
Factors that may affect readmission
Several factors that increase the likelihood of readmission may be modifiable, especially those that relate to clinician or system level issues. Such factors include:
- Premature discharge
- Inadequate post-discharge support
- Insufficient follow-up
- Therapeutic errors
- Adverse drug events and other medication related issues
- Failed handoffs
- Complications following procedures
- Nosocomial infections, pressure ulcers, and patient falls
Medical errors are a major contributor to preventable readmissions. Among medical errors, issues related to medication use are frequent. Adverse events, most commonly medication-related, have been estimated to occur in approximately 20 percent of patients following discharge2. Approximately two-thirds of such adverse events were determined to be either preventable or ameliorable.
|Initial Hospitalization||Most Frequently Reported Adverse Event|
|Heart Attack||Skin Integrity – Pressure Injury|
|Heart Failure||Admission/Transfer/Discharge – Patient Left or Absconded Against Medical Advice|
|Pneumonia||Skin Integrity – Pressure Injury|
|Chronic Obstructive Pulmonary Disease COPD||Admission/Transfer/Discharge – Patient Left or Absconded Against Medical Advice|
|Elective Hip or Knee Replacement||Medication – Allergy Override|
|Coronary Artery Bypass Graft (CABG)||N/A|
Source: Quantros Safety Event Manager data for patients with admit dates from 7/01/17 through 10/10/17.
12016 All-Cause Hospital-Wide Measure Updates and Specifications Report; CMS 2016
2Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003; 138:161.; Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ 2004; 170:345.