As part of an effort to reduce 30-day readmission rates, some hospitals are working with local skilled nursing facilities (SNFs). Several programs like this are operating throughout the country.
The Enhanced Care Program or ECP, at Cedars-Sinai Medical Center in Los Angeles began in 2011, later adding a pharmacist to the team. This service is now available for patients who are discharged seven SNFs in the area.
The program works by allowing the ECP nurses to coordinate care between the inpatient and SNF settings, working with doctors in both places to follow up on any unresolved patient care issues. Nurses meet with their patients in the hospital, assess them again within 24 hours after being admitted to the nursing facility, and then visit them at the facility at least once a week.
Rita Shane, chief pharmacy offers her at Cedars-Sinai was contacted by a doctor who was concerned about patients returning to the hospital from skilled nursing facilities because of preventable problems related to medication reconciliation. In 2013, this resulted in the addition of pharmacist Caroline Nguyen to the team.
Data from the ECP staff shows that 30 day readmissions to Cedars-Sinai from the participating SNFs happened at about a rate of 20% when the program first began. Since then, readmission rates have declined by 25%. Adding the pharmacist to the team has coincided with the downward trend in readmissions.
At Frederick Memorial Hospital in Maryland, readmissions from SNFs are also a focus of the care transitions (CT) service provided there. In 2014, the transitions team looked at the hospital’s processes for SNF discharges and admissions. CT pharmacists Patricia Cash and Andrea Backes performed a comprehensive medication reconciliation and follow-up for high-risk patients who were transitioning between the hospital, skilled nursing facility, and home settings.
Together they have compiled important lessons learned from the examination of the discharge process. Hospital doctors are not required to perform medication reconciliation for patients being sent to a skilled nursing facility, so when patients transferred to the facility, they verbally indicate their medications, which may not always be accurate. The SNF may receive one medication list with a discharge summary, and a different one with discharge instructions, which don’t always match up. When patients go home after his stay in an SNF, their discharge medication lists may contain errors or a lack of information, such as the need to discontinue a home medication if the new prescription for another drug was added.
Before the CT service was created, Frederick Memorial’s 30-day all cause, all payer readmission rate was 10.27%. After the creation of the team, that rate fell to just 8.55%. It’s clear that pharmacists help play a major role in reducing readmission rates.