Private practice with Dr Seth Bilazarian

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Strategies to lower hospital readmission rates

Jun 23, 2010 12:35 EDT


In their recent paper, Harlan Krumholz's group estimated the hospital readmission rate for congestive heart failure at 20%. Are we doing enough to address this issue? In my practice, our preventive strategies to keep readmission rates down are essentially threefold:

  • Early follow-up with the patient (within one week of discharge).
  • Clear communication pertaining to medications.
  • Frequent communication via telephone by our nurse practitioner.

 

What are your strategies to keep patients from readmitting?

See:

Bueno H, Ross JS, Wang Y, et al Trends in Length of Stay and Short-term Outcomes Among Medicare Patients Hospitalized for Heart Failure, 1993-2006. JAMA. 2010;303(21):2141-2147. Abstract.

The revolving hospital door for HF and sensory-implant guides to cut hospitalization risk

CHAMPION: "Swan-Ganz" sensor implant guides HF meds, cuts hospitalization risk





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Your comments
Strategies to lower hospital readmission rates
# 1 of 1
June 24, 2010 08:11 (EDT)
Melissa

Discussing fluid restriction suprisingly does NOT get done at each admission for each CHF patient. It should be the VERY FIRST thing that we discuss instead of just assuming that our medications have failed. Also, making the point that the pt. should "never touch a salt shaker" as long as they shall live AND to learn to keep track of sodium intake.

Another thing that seems to help in the very complex patient is to write the discharge orders by hand,....list each med....list each med that has been stopped.......list each med that has been increased or decreased.......all of the follow up appointment times and then copy that discharge order sheet and give it to the patient and fax it to the other health care providers. 

 Great job Seth as usual! I  Really enjoy your blogs!

Melissa


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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.