Award-Winning Protocol Puts Readmission Prevention Manager in ER to Reduce Rehospitalization Rates

Thursday, February 13th, 2014
This post was written by Cheryl Miller


Call it a bouncer of sorts for the emergency room: the readmissions prevention manager, or RPM for short, has helped Torrance Memorial Health System reduce all cause readmissions by nearly 5 percent, and earn its hospital system kudos from the industry, says Josh Luke, Ph.D., FACHE, vice president of post acute services at Torrance Memorial Health System and founder of the California Readmission Prevention Collaborative and the National Readmission Prevention Collaborative.

Designed to determine whether newly admitted high-risk patients are ready for the emergency room (ER), or could be placed elsewhere, the RPM is an integral part of a strategy implemented in 2013 for Total Wellness Torrance (TWT) to reduce preventable readmissions, Luke said during Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers , a 45-minute webinar on January 8th, 2014, now available for replay.

He shared the key features of this program, which was recognized by California Association of Healthcare Facilities as a Program of Excellence in 2013. At the time, the 401-bed not-for-profit hospital was achieving readmissions rates that were in step with national averages, generally within 18 to 20 percent, and some quarters exceeding that. Torrance felt it could do better, approaching the problem from an all-cause, rather than disease-specific perspective, Luke says.

Creating the RPM was the first step in the process, he says. This person would function as the leader of the hospital readmission prevention team, making sure only patients who meet criteria and need to be hospitalized are admitted either to the observation floor or to the inpatient unit.

As Luke explains: the RPM gets a real-time email alert any time a patient comes to the ER and their social security number is entered into the hospital’s electronic system. Their number one priority is then to go right to the ED to meet the patient and work with the attending doctor, case manager and nursing team in the ER to see if this patient can be cared for at a lower level of care.

That’s essentially what the Affordable Care Act has encouraged us to do and incentivized us to do and penalized us when we don’t do that efficiently, which is not to admit patients to the hospital that don’t need to be here. We are very encouraged by the success of that program in its initial six months.

The RPM then follows those patients who were not admitted to the ED to a post-acute network facility, at all times keeping in mind patient choice. TWT includes a post-acute network of eight skilled nursing facilities (SNFs), all within five miles of the hospital, and a home health agency. Along with a home health department navigator, the RPM goes to each SNF once a week to follow up on patients, determining discharge plans and employing an ambulatory case manager if the patient goes to a home health agency outside the Torrance network, and keeps tabs on them long after the 30-day readmission period is over.

Collaboration and communication with the post-acute network (PAN) is key to success, Luke says. “Whenever I’m asked if I could name three basic things to prevent readmissions, the first thing I always refer to is telling your skilled nursing facilities to invest in predictive software because it doesn’t cost you as a hospital anything. It enables you to share data with the SNFs.”

That, and always be a champion of choice for your patients, Luke adds, even when they’re being bounced out of the ER.

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