The Exec: How to Reduce Hospital Readmission Rates
By Christopher Cheney
Hospitals need a multi-pronged effort to reduce readmission rates, according to the new CMO of the Orlando Health East Florida Region.
Michael McLaughlin, MD, was named CMO of the Orlando Health East Florida Region in June. The region includes Orlando Health Melbourne Hospital and Orlando Health Sebastian River Hospital. Previously, McLaughlin held several leadership positions at Orlando Health, including serving as CMO of the health system’s hospital division.
Hospital-based care is complex, so reducing readmission rates requires a team approach, according to McLaughlin.
“You need team-based care that includes the physician, the nurse, and pharmacy staff,” McLaughlin says. “You need to move the patient through a process of care and make sure there is a discharge plan, which should begin soon after a patient is admitted to the hospital.”
To reduce readmission rates, hospitals should follow standards for length of stay, McLaughlin explains.
“For every patient that comes into the hospital with a condition or set of conditions, there is a recommended length of stay,” McLaughlin says. “We know what the length of stay should be, with a plan of care and early attention to forming a discharge plan.”
Exceeding the recommended length of stay poses risks for patients, including falls, medication errors, and hospital-acquired infections. These risks can contribute to readmissions, McLaughlin says.
Before a patient is discharged, care teams need to work with the family, so they know what to look for as far as recurrence of symptoms in the home. If there is recurrence of symptoms, the family can connect the patient with their primary care physician, which can avoid a hospital readmission, McLaughlin explains.
Ensuring that patients have their medications at discharge can limit hospital readmissions.
“Orlando Health has a Meds-to-Beds program, where medications are delivered to a patient’s hospital room before they are discharged,” McLaughlin says. “What we have found in the past is that patients may not get their medications after discharge because neighborhood pharmacies are closed by the time the patient gets home.”
Hospital care teams need to make sure that a patient knows the medications they are taking and knows how to take them, McLaughlin explains.
“Patient compliance with medications is a huge part of avoiding readmissions,” McLaughlin says.
Hospitals should have a transition care team, which helps manage patients after hospital discharge, according to McLaughlin.
“The transition care team makes sure that the patient gets follow-up appointments with their primary care physician or specialists such as cardiologists,” McLaughlin says. “Follow-up appointments should be held between 72 and 96 hours after hospital discharge.”
Finally, patients should know who to call if they are having a problem after discharge, McLaughlin explains.
Improving operating room efficiency
McLaughlin’s clinical background is in general surgery, including practicing as a general surgeon at Cape Canaveral Hospital for 28 years. Just as in the case of avoiding hospital readmissions, teamwork is essential to boost operating room efficiency, according to McLaughlin.
“It involves the surgeon, anesthesiologist, nurses, scrub technicians, anesthesia technicians, registration staff, pre-operative testing, and transport staff,” McLaughlin says. “The transport staff plays an underappreciated role in getting patients in and out of the operating room in a timely manner.”
Turnover teams are essential for operating room efficiency, McLaughlin explains.
“You need a team to move the patient to the recovery unit. You need a turnover team to clean the room before the next patient,” McLaughlin says. “An operating room can be down for as long as 40 minutes as the operating room is prepared for the next patient.”
One strategy to reduce operating room turnover time is to schedule the least complicated cases to a particular set of operating rooms, so the anesthesia tech, scrub tech, and inter-operative nurse can play a key role in turning over the operating rooms quickly, according to McLaughlin.
How CMOs can balance priorities
A CMO must walk a fine line between promoting clinical care on the one hand and financial considerations on the other hand, McLaughlin explains.
“A CMO must navigate between patient care and the objectives of the business because a hospital that is not doing well financially will ultimately impact the community because the hospital is not going to survive,” McLaughlin says.
For example, a physician may want a new robot, and the CMO must weigh the costs and the benefits, according to McLaughlin.
“A CMO needs to look at how much the robot costs and whether there is a true benefit to the patients,” McLaughlin says. “If the finances do not make sense and there is no added benefit to the patients, the answer is going to be ‘no’ as long as there is an alternative that is just as good.”
For a CMO, balancing clinical care with financial realities is part of the job, McLaughlin explains. CMOs are responsible for evaluating the clinical aspects of new procedures, new devices, and new technology.
“One of the considerations is whether any of these things benefit patients,” McLaughlin says. “Another consideration is the finances, because without the hospital being financially stable the healthcare is going to suffer.”
Christopher Cheney is the CMO editor at HealthLeaders.