10 Common Causes for Hospital Readmissions
When you return home from a hospital or care facility stay, you still run the risk of complications with your health. Approximately one in six U.S. Medicare patients who leave a hospital will be readmitted within 30 days.1 Katherine Watts, Director of Medical Social Services at Lexington Medical Center, and Lorraine Grote Johnson, Director of Care Quality at Right at Home, compiled a list of common causes for hospital readmissions. While this isn’t a complete list, it will help you play an active role to ensure your recovery at home is successful so you can avoid another hospital stay.
1. Medication errors or lack of accurate medication history.
Medication errors can often be traced to a patient’s medication history that does not reconcile with the prescriptions ordered by doctors in the hospital. Hospital doctors may look at necessary medications differently than your primary care physician or specialist. To help with better tracking of all medications, many hospitals direct their pharmacists to review medications and identify which medications counteract or are duplicates and pose other health risks. You can play an active role in avoiding medication errors by providing a complete medication history including prescriptions, over-the-counter medications and supplements.
2. Medication noncompliance by the patient.
Once home, it’s important to take your medications as prescribed. Taking an incorrect dosage, skipping a dosage, or taking medication at the incorrect time increases your chances of another hospitalization. If you are concerned about the cost of medications, ask your doctor or pharmacist about cost-effective alternatives or programs to help offset the cost. If managing the timing and dosage of medication is an issue, ask your pharmacist for tools that can assist, or consider the help of a professional caregiver.
3. Fall injuries.
When you return home, you may be weak, unsteady on your feet, or dealing with cognitive impairment. These conditions could put you at risk for falls. If you are using new or different durable medical equipment such as a walker, oxygen, or assistive equipment in the bathroom, your risk of falling also increases as you learn to use the new equipment. The Right at Home Fall Prevention Guide can help you lessen your fall risk by showing you how to prepare your home for a return from the hospital or care facility.
4. Lack of timely follow-up care.
Hospitals typically recommend that you follow up with your primary care physician or specialist within a week to 10 days after discharge. Some specific diseases like congestive heart failure may require follow-up sooner. Whenever you miss timely follow-up care, you potentially jeopardize your recovery and put yourself at risk of another hospitalization. Often times, confusion around scheduling can keep you from attending these important appointments. Ask your care team about resources to assist you with scheduling so you don’t miss this important part of your care.
5. Failure to identify post-acute care needs.
Sometimes in the complexities of discharging patients from the hospital, the care you need at home may not be fully addressed. Some chronic or severe disease conditions such as congestive heart failure, septicemia and heart attack require more supervised care upon discharge. The hospital may suggest home health services as you transition home from the hospital, but your nonclinical needs may not be addressed. Be open about your support system at home and any nonmedical needs you may need assistance with.
6. Inadequate nutrition.
If you eat nutritious foods at home after a hospital stay, you increase your chances of healing and returning to your normal activities sooner. Your risk of malnutrition increases if you have difficulties getting out to buy groceries or making your own food. If you struggle with chewing or swallowing, or have a poor appetite because of your health condition, you may not be getting the nutrition you need. Ask your doctor or a nutritionist about resources to ensure your specific nutrition needs during recovery are being met.
7. Lack of transportation to access care.
Many seniors in particular find it difficult to get to a doctor because they can no longer drive or have no reliable transportation to medical appointments. When discharged individuals cannot make it to a doctor, some will call an ambulance and end up in the emergency room and are readmitted even though their medical concern could have been treated at their doctor’s office.
If you have a wound or incision when you are discharged, it is vital that you and your in-home care team know how to take care of the area to prevent infection. Ask your medical team for a list of infection symptoms and red flags that indicate you should seek immediate medical treatment. Protect yourself from infections at home by following thorough hand washing and sterilization guidelines when handling bandages, tubing and other medical supplies.
9. Too early of hospital discharge.
You may appear ready to finish your recovery at home, but perhaps you would benefit from a stay in a skilled nursing facility before returning home. You may be discharged too early if an underlying complication is overlooked, or if there are communication issues within a healthcare team. The day and time of your discharge can also affect your chances of a readmission. If you are released late on a Friday or over a weekend, it is important to ask what resources are immediately available to you should you need them.
10. Inadequate discussion of palliative or hospice care.
If you are facing a long-term or terminal prognosis, hospitals and healthcare providers may focus on fixing your immediate health problem and not approach the difficult conversation about palliative or hospice care. Without this important information, you may face repeated hospital admissions for pain or continued decline in health.
For more information and resources to help ensure a safe and smooth transition home from the hospital or other care facility, visit RightTransitions®.
1 Healthcare Cost and Utilization Project. Characteristics of 30-Day All-Cause Hospital Readmissions, 2010-2016. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb248-Hospital-Readmissions-2010-2016.jsp.