REDUCING HOSPITAL
READMISSIONS:
KEYS TO QUALITY CARE
Casey King, LNHA
Dana Andrews, MD MHSA
Tammy Mejia, RN DON CWCA
Winchester Terrace Skilled Nursing and
Rehabilitation Center
Speaker Disclosures:
Dr. Dana Andrews, Casey King, BA,BS,MA,LNHA and
Tammy Mejia, RN, DON, CWCA have disclosed that
they have no relevant financial relationship(s).
Learning Objectives:
By the end of the session, participants will be able to:
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Understand the impact hospital readmissions have on
the referring hospital, long-term care facility and the
patient
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Identify the tools and methods necessary to implement
a program to reduce rehospitalizations

Implement a process that will:
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Maintain continuity of care during acute illnesses
Deliver quality care within the skilled nursing facility
Reduce hospital readmissions from skilled nursing facility
Did You Know ?????
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1
One in four Medicare patients are readmitted
to hospital from skilled nursing facility within 30
days
Up to 2/3 of hospital transfers are avoidable
Medicare is planning financial incentives to
reduce potentially avoidable hospital transfers
through
pay for performance
bundled payments

1
Information provided by INTERACT II
CMS to Enforce Penalties
Hospitals will face penalties for patients
who are readmitted for :
•
acute myocardial infarction,
•
heart failure
•
pneumonia
starting in the fiscal year 2013 and the
list will be expanded in 2015
Rehospitalizations Negative Impact
Nursing Facilities
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Loss of continuity of care for resident
Loss in revenue to facility
Ultimate loss in referral source if
readmission rate unacceptably high
Loss of confidence by residents, families
and physicians
Data Comparison and Benchmarking

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National Average for hospital
readmissions 19.8%
National Averages for readmission on
CMS targeted diagnoses
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CHF 24.8%
Pneumonia 18.4%
Acute myocardial infarction 19.8%
Facility Goal

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Reduce rehospitalizations of skilled
residents from current 2009 rate of 30.5 %
to less than 15%
Improve relationships with local hospital
Increase communication between nurse
and physician
Facilitate customer satisfaction
Causal Factors Identified

Inadequate nursing assessments

Poor communication skills between nurse
and physician

Lack of physician confidence in staff
providing care/treatment within the
facility
Keys for Process Improvement

Development of a program that would
provide nursing with an easy to use
system that flows from one process to the
next with focus on:
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Nursing Assessment
Early identification of acute changes in condition
Communication of acute changes by staff to
nursing
Effective communication of clinical picture to
physician
Research and Resources
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INTERACT II http://interact2.net
Provides tools useful in management of
acute changes in resident conditions
The SBAR communication tool
Clinical Care Paths
Acute Care Transfer Log
Quality Improvement tool for review of
acute care transfers
Research and Resources
 AMDA http://www.amda.com/
Protocols for Physician Notification-

Assessing and Collecting Data on Nursing
Facility Patients
Clinical Practice Guidelines
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Heart Failure
Common Infections in Long-Term Care setting
Acute Change of Condition in Long-Term Care
setting
The SBAR

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Cues the nurse to evaluate body systems,
symptoms and collecting data physician needs
when ordering treatment plan.
Enhances confidence in nurse/physician
relationship
Used each time a condition change recognized
Guides the implementation of appropriate care
path
Assists nurse in making requests of physician
for additional testing/medication changes
Streamlines documentation-serves as nursing
documentation and physician/family notification
Clinical Care Paths
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Development of care path topics were
based on:
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Those conditions that were identified as
significant reasons for readmission to
hospital
Those conditions CMS would target for
rehospitalization penalty
Clinical Care Paths
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Improves nurses’ capability to assess
signs and symptoms
Prompts the actions to take related to
clinical data collected
Denotes problem, interventions and goalserving as an episodic plan of care for
nursing
Clinical Care Paths
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Urinary Tract Infection
Congestive Heart Failure
Respiratory Infection
Altered Mental Status
Fever
Dehydration-potential
Education and Training
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Emphasized the effect the process will
have on quality care and customer
satisfaction
How and when to use the SBAR
Implementation and use of care paths
Scenario training and case reviews of
SBAR and care paths
Unlocking the Success
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2009 - 30.5 % of skilled residents were
readmitted to the hospital within 30 days
of admission
2010 - 13.48% of skilled residents were
readmitted to hospital within 30 days of
admission
2011- 10.6% of skilled residents were
readmitted to hospital within 30 days of
admission
Unlocking the Success
Conclusions
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Maintained continuity of care during acute
illness episodes
Delivery of quality care to our residents
Solidified relationships with attending
physicians
Gave nurses tools/methods to confidently
care for our residents
Reduction of hospital readmissions to less
than 11% for skilled residents
Questions???
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Casey@leveringmanagement.com
Tammy@leveringmanagement.com
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Winchester Terrace Skilled Nursing and
Rehabilitation Center
70 Winchester Rd Mansfield Ohio 44907
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419-756-4747