MADRID--Once they finally get to see the patients, today's hospitals seem to be adequate at acute emergency care, but they are often falling short at preventive care.
Yesterday SmartPlanet discussed Spanish hospitals' innovative push for efficiency, focused on admission and discharge departments. Part 2 of this series concludes by taking a more general look at lowering re-admission rates as a form of preventive care. These rates are typically defined as re-entering the hospital within 30 days of the last visit.
The Advisory Board Company's managing director David Willis said, "The real problem is the change in the type of patients--the number of people living with chronic disease, an aging population, a change of lifestyle, and an increase in obesity."
At Monday's conference between 16 Spanish hospitals and ABC, one hospital administrator said, "There are more and more chronic disease patients, and there are many different ways to manage these diseases." Management of chronic patient care and capacity management are two of the most significant challenges facing Spanish hospitals.
With the Spanish life expectancy of 81.2 years making for the largest population of seniors ever, dementia and Alzheimer's patients are many of the likely-to-be-re-admitted patients. This is often because these patients do not remember to take their medicine or to attend their follow-up appointments.
ABC argues that there must be a change in the discharge and follow-up process to avoid the increase of re-admission rates by preventing further acute emergency cases. They suggest that one of the main obstacles is a lack of information sharing with hospitals, patients, and long-term care providers. An obese patient with congestive heart disease needs to be advised about diet, while the caregiver of an Alzheimer's patient must be notified about any changes in medication. ABC advocates for an "It takes a village" approach, in which the hospital interacts with the surrounding community--nursing homes, at-home visiting nurses, dietitians, and the like.
Willis says that the moment of care transition is a good place to start, suggesting making the patients "subjects rather than objects of care."
He also says hospitals cannot work generally and should individually research--or hire research companies--to identify the specific groups of patients each community has that are at-risk for re-admissions. ABC says that less than a quarter of hospitals are currently conducting interviews of re-admitted patients. Madrileños suffer from abnormally high levels of asthma due to high rates of air pollution, therefore this would be a logical research focus for Madrid hospitals.
Many of the challenges that can lead to unnecessary re-admission are operational, when the patient does not receive thorough discharge instructions or follow-up appointments are not scheduled. Other obstacles are psychosocial, like an inability to pay for prescriptions, a lack of transport to follow-up visits, or a low health literacy leading to non-compliance with discharge instructions. Lower income patients tend be one of the most common groups for re-admittance.
Once the patients at-risk for re-admittance are identified, most of the action plans seem to fall on the nurses, who are already overworked. These plans range from more forms for them to fill out, which explain medication and lifestyle changes, to longer conversations between nurses and caregivers.
Boston University has created avatar nurse "Louise" to compensate nurses' time. Louise is a re-playable patient advocate who "provides teach-back style education to test patient retention." Afterwards, if a patient or caregiver has more questions, they then can ask the nurse or doctor. Louise ended up saving nurses 30 minutes per patient of the time normally spent on patient education. Meet Louise here.
ABC contends that at-risk re-admittants should be prioritized based on risk. They argue that hospitals should hire staff or ask for volunteers to call and follow-up with the patient groups identified as at the highest risk of re-admittance.
We can check back in the coming months and years to see if Madrileño hospitals, along with those worldwide, make the necessary procedural changes for improved efficiency and patient care. Please share your opinions and any suggestions.
For more information on the Madrid health system, visit the official statistical site.
This post was originally published on Smartplanet.com