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Nurse and patient surveys can reduce hospital readmission rates

Keeping patients from a return trip to the hospital after discharge is important for both the patient and the hospital. Readmissions are expensive, reduce the patient’s overall health, and burden caregivers.

Hospitals are in the midst of pursuing a myriad of strategies to minimize readmissions and many of them involve engaging patients and every member of their care team. A new study (published in the Journal of the American Medical Association) directed by a team of nurses, including Kathy Bobay, PhD, RN, NEA-BC, FAAN found that a brief survey completed by nurses and patients prior to discharge can reduce readmission rates.

Dr. Marianne Weiss, DNSc, RN, professor of nursing at Marquette University, led the three-person research team which included hundreds of nurses and economists from across the country. More than 144,000 patients and 1500 nurses from 33 hospitals nationwide participated in the survey, conducted from 2014 to 2017. 

“This study shows the value of nurses, and allows them to help with the discharge process in a way that allows them to advocate for the patient,” says Bobay. “This leads to overall better patient care and patient satisfaction goes up as well.”

The READI study (Readiness Evaluation and Discharge Interventions) includes eight questions each for the nurse and the patient. Their responses help determine if there are indicators that a patient should not be discharged. Questions focus on four areas of readiness:

• Personal status (physical energy and readiness)
• Knowledge (aware of problems to monitor and other restrictions)
• Perceived coping ability (can handle demands at home and self-care)
• Expected support (assistance with medical and personal care)

According to the results, readmission rates were reduced by up to 1.79 percentage points when nurses conducted the READI assessments on the day of discharge and included direct patient participation. These results are from units with readmission rates greater than 11.5 percent at baseline.

The Affordable Care Act penalizes hospitals with excessive readmissions within 30 days of initial care. The penalties aim to encourage better care, and have led hospitals to examine how to institutionalize and reduce readmission rates in cost- and time-efficient ways.

Bobay notes that patient involvement in the discharge process is just as important as nurses and physicians recognizing signs that a patient is not yet ready to go home. Results also indicate that the READI assessment, “shows the value of what nurses do, and potentially assigns a cost savings value to nurses doing this work.”