Emergency department intervention lowers readmissions

Opportunity to Improve

Mercy Health — Youngstown has three acute care hospitals in Northeast Ohio: St. Elizabeth Youngstown Hospital, St. Elizabeth Boardman Hospital, and St. Joseph Warren Hospital. Conduit came to us in the third quarter of 2018 with a proposal to help us identify patients who are at risk for readmission after one hour in the emergency department. Conduit would review the emergency department census to find patients who triggered potential 30-day readmission. Critically ill patients weren’t included. Any patient with a risk of 30-day readmission would trigger a phone call from Conduit to our emergency department partner letting the physician know that the patient has a potential for readmission. The goal was to consider alternative forms of admission.

The Need

Our goal was simple. We had a large number of readmissions that were creating a substantial value-based purchasing penalty. By implementing several strategies, we’re closer to our goal of neutrality regarding observed to expected ratio. With the addition of the Conduit strategy, we were able to reach and then exceed it by reducing our composite (heart failure, pneumonia, COPD) readmissions during the measurement period to 0.85 observed to expected readmissions. We expect to reduce uncompensated care due to contractual obligations or readmissions, avoid value-based purchasing penalties and improve the health and welfare of our patients.

The humanitarian side of this intervention is immense. A hospital-dependent person doesn’t want to be in a hospital. Our ability to develop strategies and interventions to avoid these readmissions not only keeps patients in their preferred environment but also takes a burden off the family members that would be coming to a hospital for daily visits.

The Solution

We recognized best practices occurring on one campus and integrated it on the other campuses. Key  stakeholders for each disease process were engaged. Conduit Health Partners helped our team with the emergency department recognition. 

The Benefit

Our readmission rate was 1.18 at the time we reinvigorated our readmission task force. We achieved an overall reduction of readmissions to below 1.0 during the measurement period.

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