The High Cost of Hospital Readmissions

Hospital readmissions are common, especially among patients tended to by family caregivers. In fact, a study from the Canadian Institute for Health Information reported that in 2010, nearly one in 10 acute care patients returned to the emergency department within seven days of hospital discharge. According to a commentary in The Journal of the American Medical Association, hospital readmissions “remain prevalent, costly and largely preventable.”

The causes of hospital readmission are many, but uncontrolled symptoms such as pain, breathing difficulties, vomiting, infection and diarrhea are among the most common, says Betty Ferrell, director of the division of nursing research and education at City of Hope in Duarte, Calif. In many cases, Ferrell adds, readmissions occur because family caregivers feel panicked or overwhelmed.

According to Ferrell, who is involved in caregiving research sponsored by the National Cancer Institute and the American Cancer Society, preparation is key to reducing the potential for hospital readmission. “Caregivers have to be really assertive when their loved one is scheduled to go home from the hospital,” she explains. “They need to ask, ‘When can I meet with the nurse or physician, because I need a heads-up now—not three days from now—about what Mom is going to need at home.’”

Ferrell also emphasizes the value of thorough and accurate documentation, including a medication record and a pain log, so that problems can be addressed through early intervention.

Foremost, caregivers should have a hospital discharge checklist when the patient returns home. It should include:

> A comprehensive discharge plan from the patient’s primary care team.

> A medication list, including what each drug does, when it should be given and potential side effects, as well as instructions for modifying certain medications (such as those used to treat pain).

> A list of medical providers the caregiver can call with questions or concerns.

> A list of the patient’s follow-up appointments, including when, why and with whom.

> What to expect within the first 30 days of discharge, including red flag symptoms.

> Approved websites or apps that may assist caregiving.