Avoiding Hospital Readmission

When you’ve just gotten out of the hospital, you’re ready to start enjoying the comfort of home again and getting back on your feet and the last thing you want is to have to go back in.

Sometimes people with chronic illnesses may be admitted to the hospital repeatedly, but many readmissions are avoidable, particularly for one-time procedures like hip and knee replacements. The Affordable Care Act, or Obamacare, encourages hospitals to work to reduce readmissions, but unfortunately much of the burden still falls on families. Repeated hospital stays put unnecessary financial pressure on you and your family and can put you at risk for infectious diseases and worsen conditions like dementia.

So what can you do to reduce the chances that you’ll end up back in the hospital for something that doesn’t warrant a trip? There are four major causes of preventable hospital readmissions:

  • Problems with medication management
  • Confusion about your care plan
  • Missing your follow-up appointment with your primary care doctor
  • Insufficient home support

We’ll address each of these causes in detail and offer practical advice to manage your health when you’ve just been released from the hospital. It’s important to remember that sometimes readmission is unavoidable. If you are having any kind of unusual symptoms, you should call 911 immediately and return to the hospital.

Polypharmacy

Polypharmacy refers to the effects of taking multiple medications for coexisting health problems, such as diabetes and hypertension. Often this is a necessary part of healthcare as you age, but nearly 50% of older adults take medications that are not medically necessary. This creates unnecessary healthcare costs as well as preventable hospitalization from dangerous medication interactions. It is always important to stay on top of your medications, but it can be particularly confusing when you have just been discharged from the hospital. So what can you do to make sure you’re only taking the medications you need?

Use a pill box.

Keeping your medications organized is important for preventing overdoses or missed medications. Particularly if your loved one has dementia, it is essential to have a pill box set up so they can clearly see whether or not they have taken the day’s medication. A family member can help out with this, or your home care provider can send out a nurse to help with med management.

Keep your prescriptions up to date.

Often seniors, particularly if they have dementia, continue to take old meds that they are no longer prescribed. It is very important not to keep old prescriptions around the house. Many pharmacies will take old prescriptions back and dispose of them safely. If your pharmacy does not accept old medications, you can throw them away or flush them. Patients may use more than one pharmacy so doctors and pharmacists are not aware that conflicting or redundant medications are being prescribed.

Always use the same pharmacy.

When you’ve just been discharged from the hospital, you’ll have a long list of medications from your specialists in addition to any you might have been taking before you went in. The simplest way to avoid complications is to make sure you are using a single pharmacy for all your prescriptions. The pharmacist is able to see all the medications prescribed by all your doctors, and will notice interactions that might otherwise be found until they’ve already caused problems. If you spread out your prescriptions across a couple of different pharmacies, the pharmacist will not be able to check your med list for interactions.

Talk to your primary care doctor about your medications.

Good communication between your doctors is the best way to prevent polypharmacy problems. You should have a followup appointment with your primary care doctor in the first two weeks after you leave the hospital. Your primary care doctor knows your medical history better than any of your specialists and can help reconcile your prescriptions so there are no conflicts or redundant medications. Bring the prescriptions you were given at the hospital and a list of any over-the-counter medications, vitamins, or herbal supplements you have been taking.

Follow Up with Your Primary Care Doctor

Your primary care doctor knows you and your medical history better than anyone else. It’s important that you make time to see your doctor as soon as possible once you’ve been discharged from the hospital. Kaiser Southern California studied over 100,000 hospital readmissions and found that seniors were three times more likely to be readmitted for preventable problems if they didn’t have a follow-up visit with their primary care doctor after leaving the hospital.
When you leave the hospital, make sure you know which doctor will be overseeing your care after discharge, and get a copy of your discharge summary. Ask the social worker or the geriatric care manager to help you schedule a visit with your primary care doctor within a week from your date of discharge. If it is difficult for you to get to your doctor, your home care provider or a medical transport service will be able to help with transportation. Many public transit systems also offer accessibility services.

Your primary care doctor can address concerns about symptoms and will help catch any complications before they get out of hand. They will be able to tell you whether symptoms are a normal part of recovery, or if there is a problem that needs immediate attention. This is especially important with complex procedures like heart surgery.

When you go, bring a copy of your hospital discharge summary with you and give it to your doctor. Make sure they go over your list of medications and any care that you will need at home. If the doctor makes any changes to your medications or to your care plan, make sure you get a copy and that your home care provider and your care manager also get copies.

Before you leave, remember to ask about options for after-hours care.

Understanding the Care Plan

Just before you are discharged from the hospital, your doctors will visit you to go over your plan of care. It’s important to make sure you understand your care plan before you leave the hospital, but it can be very confusing when you are just starting to recover from an illness. It always helps to have a second pair of eyes, so ask a family member or friend to help you through the discharge process: they can take notes for you and ask questions.

If there is anything on your discharge plan that doesn’t seem to make sense, don’t be afraid to ask about it. We had a patient once whose discharge sheet said that he needed to be on a low-salt diet and on salt pills, and no one caught it until the home care nurse came to do an assessment and called the patient’s primary care doctor.

If you’ve already left the hospital, your follow-up visit with your primary care provider is a great opportunity to clarify anything you don’t understand on your care plan. The care plan is part of your clinical records, so your primary care doctor will be able to get access to it and help you with anything you don’t understand.

When you get home, make sure the care plan is posted somewhere where it is easy for you, your family, and your caregivers to see. Familiarize the family with any special instructions, and ask someone to help you post reminders for yourself wherever you store your medications.

Home Support

When you’re coming home from the hospital, it’s important that you have all the support you need at home before you arrive. You might need help managing your medications and preparing food, and it may be difficult to do household chores right away. If you’re going home to stay with family, they can help out, but if you live alone then you might need outside help from a caregiver until you’re strong enough to stay on your own.

Before you go home from the hospital, find out what equipment you will need at home so you can get everything in place before your discharge. While you are still at the hospital, you should also talk to the social worker about balancing your care with your family’s daily life to see if you will need extra help at home. If so, speak to a home care agency and set up care before you leave the hospital. Family and caregivers can help you with everyday tasks, and they may notice changes in your condition before you do.

On the day of your discharge, make sure someone is able to help you pick up your medicine and some groceries on the way home from the hospital. If you can’t find a friend or family member who’s available to help you, talk to the social worker or care manager at the hospital and ask if there is an accessibility service or a nursing agency in the area who could send someone to help you come home from the hospital.