If hospitals want to cut readmission rates, do a better job teaching patients about self-care

Heidi Steiner

A fundamental reason why hospitals consistently fall short on readmissions is a failure to empower and educate patients.

An older man is rushed to the emergency room suffering from a rapid pulse, severe thirst, and drowsiness — classic symptoms of a diabetic crisis.

After a few days of treatment, he’s discharged by an overworked nurse with some written instructions and a hasty explanation of how to care for himself and avoid a relapse. A few weeks later, the patient is back in an acute-care hospital bed.

It’s a cycle that’s repeated day-in and day-out across the United States, and one that is imposing a heavy financial burden on the nation’s hospitals and health systems.

More than 80% of eligible U.S. hospitals are being hit with penalties this fiscal year for falling below national standards on the number of Medicare patients readmitted within 30 days with a range of acute and chronic conditions, continuing a costly trend since the fines were introduced in 2012. In 2019, the penalties cut hospitals’ Medicare payments by more than half a billion dollars.

A fundamental reason why hospitals consistently fall short on readmissions is a failure to empower and educate patients.

This will be evident to many patients who’ve been unfortunate enough to spend time in an acute-care setting. Typically, they spend a few days in a blur of sickness and treatments before receiving discharge papers and some hurried instructions that they can’t properly understand or absorb. This sets patients up for failure, with a higher chance of returning to the hospital within weeks.

The patient’s experience and their prospects of avoiding another visit can be transformed if they are properly educated about their condition and how to care for themselves after being discharged. Healthcare professionals’ ever-increasing focus on task-oriented processes, such as electronic health records, has tended to take the focus away from patient-centered care. The pendulum needs to swing back to improve patient outcomes and lower readmissions.

Rather than bombarding patients with complex explanations and medical jargon, nurses and other practitioners should communicate with them in simple language and focus on the core survival skills they need to avoid a relapse, with a plan to expand on the education with their provider after discharge.

For the diabetes patient, that could mean understanding how it feels to have high or low blood sugar, how to administer an insulin shot, how to reach a doctor, and some basic dietary recommendations.

The education process needs to be consistent rather than a hurried one-off talk at the end of a stressful and overwhelming few days. Clinicians should assume that patients have low health literacy (as most do) and avoid peppering them with “med-speak”.

Just because patients say they understand doesn’t mean they do. They could be embarrassed at not understanding certain terms, or they could be anxious or confused due to their condition. One study found that patients forget between 40 percent and 80 percent of health information they receive and that nearly half of what they do remember is incorrect.

That’s why it’s so crucial for medical teams to apply the “teach-back” principle to ensure that patients have fully absorbed the information they need to know. Nurses and other practitioners should regularly prompt patients during their stay, beginning at admission, to repeat back the key information they’ve been told about their condition and post-discharge care.

This technique works. A 3-day teach-back program implemented by the Lehigh Valley healthcare network in Pennsylvania resulted in a 24% reduction in readmission rates as well as a 25% reduction in the average length of stay.

While nurses should play the role of quarterback, every member of the clinical team has a job to do in educating and empowering patients. Every clinician who interacts with a patient during their stay should reinforce the core lessons and work as a team to fill any gaps or weaknesses in their understanding.

Practitioners should understand how and when a patient absorbs information most effectively and act accordingly. For some, that may mean explaining the survival skills to them at certain times of the day or in the presence of a spouse or other relative who has better health literacy.

The COVID-19 pandemic has opened new ways for hospitals to communicate with patients and support them during and after their stays.

Telehealth tools are a great way for teams to stay connected with patients and to ensure they are putting their survival skills into practice at home. The pandemic has also highlighted the need for patient care plans to be more transparent, portable, and accessible to a wider range of professionals.

Care plans should be designed to encourage interoperability so that all disciplines can access them to coordinate care and move the patient forward.

Putting the patient empowerment principle into practice requires effort and planning, but it can yield transformative results — both for patient outcomes and for hospitals’ bottom line.

Heidi Steiner is a senior manager in the healthcare consulting practice at Plante Moran.