The Waste of Hospital Readmissions Can Be Reduced

Rework is waste. You shouldn’t have to bring a product back to your factory for additional work if everything was done right the first time.

That lean concept can be applied, to some extent, to rehospitalizations. When a patient has left a hospital, a return visit – at least in some cases – should not be necessary.

But many return visits occur. Health Leaders Media reports on a new study published in The New England Journal of Medicine. The authors of the study analyzed Medicare claims data for 2003-2004. They found that nearly 20 percent of discharged patients are readmitted to the hospital within a month, and the figure jumps to 34 percent when looking at three months.

Not every readmission is waste. The authors of the study estimate that about 10 percent of the readmissions were planned. And sometimes patients require readmission even when everything was done right the first time.

But readmission rates vary widely among hospitals, and the authors believe that much can be done to bring the rates down. Although he doesn’t use lean terminology, one doctor seems to suggest the problem is we’re not looking at the total value stream.

"In order to address this issue, we are going to wind up addressing the most profound issues in healthcare today," says Stephen Jencks, MD, MPH, a lead author of the study and independent consultant in healthcare safety and quality. "Issues like a system which has become provider-centered rather than patient- and family-centered. If your concerns stop when the patient goes out the door of the hospital or start when the patient comes in the door of your office, you're not going to provide the care that's necessary to keep people from being rehospitalized."

Unnecessary readmissions occur because some patients and families are not properly educated about what follow-up care must occur, and the resources are not put in place to provide that care. Lacking that care, discharged patients deteriorate to the point where readmission is required.

The article mentions several recommendations for improvement, many of which involve better education of patients and their caregivers. However, my favorite has to do with the workflow involved in scheduling a follow-up appointment.

Prevent the patient from leaving the hospital without a follow-up appointment of some kind. In his study, Jencks and his colleagues found that about 50% of patients who were rehospitalized had not been seen by an interim physician after 30 days. Hospitals often say that they can't make an appointment in that short of a timeframe for a patient's follow-up care, says Jenks. "My answer is, well if you can't get it how do you think the patient's going to get it?"

In 2004, $17.4 billion was spent caring for patients readmitted to the hospital; Medicare paid hospitals $102.6 billion in total that year. This issue is significant.