Ask ECRI: Preventing Short-Stay Readmissions
January 9, 2023 | Aging Services Risk Management
A member recently asked for information regarding preventing hospital readmissions among short-stray residents. In our response, ECRI notes that every care transition carries increased risk of adverse events, poor health outcomes, emotional instability, and high healthcare costs—and the risks are even more elevated for older adults, especially for those with multiple chronic conditions.
Although research has mainly focused on transitions from hospital to home or skilled-nursing facility (SNF), a few studies have highlighted the need for increased attention on short-stay patients. A Department of Health and Human Services' Office of Inspector General report found that 22% of Medicare beneficiaries who had spent 35 days or less in a SNF for rehabilitation after hospital discharge experienced an adverse event. Fifty-nine percent of the adverse events were deemed preventable by physician reviewers and 79% resulted in prolonged SNF stay, transfer to a different SNF or postacute facility, or hospitalization. Problems related to medication and patient care accounted for most of these adverse events, followed by infection-related events. (OIG) Another study found that fewer than 53% of short-stay patients at SNFs have a successful—meaning no hospitalizations or deaths within 31 days—discharge home or to community-based services (Guzik and Kothari).
Reducing hospital readmissions has long been an area of focus as they are associated with a quadrupled mortality rate within 100 days (Burke et al "Hospital"). Although national initiatives such as the SNF Value-Based Purchasing program aim to incentivize facilities in improving postacute and transitional care services, monetary penalties or incentives only go so far without providing SNFs the tools and resources needed to make such improvements. In fact, the program did not offer a viable path for nearly all (99.3%) low-performing SNFs to avoid financial penalties through improved readmission rates (Burke et al. "Skilled"). These results suggest that postacute care providers need actionable improvement guidance that hinges on current best practices.
Compared with long-term residents, short-stay patients generally have higher acuity and are often recuperating from a hospital stay for an acute condition, such as a stroke or procedure. Despite their higher acuity, they also tend to need more use of clinical equipment, ancillary postacute or subacute services, and care coordination with specialty providers, possibly including transportation. Thus, short-stay patients may need closer monitoring, quicker recognition of problems,...