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Four Risks That Could Lead to Unexpected Readmissions for Elderly Patients

By Jonathan Springston, Editor, Relias Media

The authors of a recent paper have identified four factors specific to older patients that raise the risk of an unplanned hospital readmission within one month after initially leaving a facility.

Researchers studied the data of more than 6,000 patients age 65 years or older who underwent colorectal, pancreatic or hepatobiliary, hernia, thyroid or esophageal, and appendix operations between 2014 and 2016 across more than two dozen medical facilities. Patients of this age account for 43% of all Americans who undergo inpatient procedures. Such patients are more likely to experience adverse postoperative outcomes. (In this study, about one in 10 were readmitted unexpectedly.)

Among these patients, those with cognitive impairment requiring another person to sign the patient’s consent form for the operation (“incompetent at admission”), those who use a mobility aid, those at fall risk at discharge, and those needing skilled care after discharge were most likely to be readmitted unexpectedly.

Unexpected readmissions cost everybody more money, lower quality scores, and could set off a whole series of even worse adverse outcomes for these patients.

“Our findings could impact clinical practice,” Florence E. Turrentine, PhD, RN, lead study author and associate professor in the department of surgery at the University of Virginia, said in a statement. “It is not clear that hospitals are using geriatric variables in evaluating patients. Our results support screening for use of a mobility aid or having a surrogate sign consent when hospitals admit geriatric patients for surgical care.”

Addressing mobility aids and proper completion of consent forms can be addressed as part of the thorough preparation that should happen before a procedure. Indiana University (IU) Health is reducing hospital stays by providing patients with a bag of items before surgery that help them “tune up” their health and position them better to ward off hospital-acquired infections (HAIs), as reported in the March issue of Hospital Peer Review. By improving the preoperative health of a patient, hospitals can shorten length of stay (LOS) and lower the rate of HAIs, which in turn refines outcomes and lowers costs.

IU Health patients at the pre-anesthetic testing center receive a red roller bag that includes a five-day supply of an immunonutrition drink with vitamins and nutrients that can bolster the immune system and improve healing. The kit includes two doses of a preoperative bathing solution, soap that can help prevent MRSA and other infections, topical mupirocin for the nostrils, an incentive spirometer to help strengthen the lungs, educational materials about smoking cessation, and an instruction sheet on how to use the contents of the bag.

But just as important as preoperative preparation is following up with especially vulnerable patients once they have gone home. A program in the Chicago area is demonstrating the value of tailoring discharge plans to the particular needs of elderly patients with little support outside the hospital, as also reported in the same issue of Hospital Peer Review.

These “solo seniors” often deal with complex medical challenges after discharge and can experience high rates of readmission without help from family and friends. With hospitals facing significant penalties from 30-day readmissions, the program could be a model for hospitals to emulate. Seniors Alone Guardianship & Advocacy Services is a not-for-profit program that works with Chicago-area hospitals to closely monitor elderly patients after their release from the hospital.

The Seniors Alone team includes experienced nurses, social workers, care managers, attorneys, and guardians. They work with healthcare providers, courts, and long-term care resources to ensure patients receive appropriate care.

If a hospital called on the program to assist with the discharge plan for a solo senior with a broken hip, the team would choose the rehabilitation facility and make post-rehab living arrangements. This would include finding a skilled care facility or home healthcare agency, coordinating with Medicare and Medicaid, and monitoring the patient’s ongoing health.

“To us, it’s a social justice issue. This country doesn’t have a great way to take care of our seniors,” said Seniors Alone Founder and Board Chair Teri Dreher, RN, CCRN, iRNPA. “With 10,000 people turning 65 every day, hospitals that can figure out how to best provide care management for these seniors without any support will serve their community better and reap benefits of their own, too.”

For even more information on these topics, be sure to read the latest issues of Same-Day Surgery.