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Keeping tabs

Hospital works to make sure patients leave happy, don't return

It used to be that when patients left El Camino Hospital, they left the health care facility behind them. But these days, since the passage of the Affordable Care Act, many patients end up taking a piece of the hospital with them.

After leaving the hospital, El Camino patients who are deemed to be at high risk for readmission are monitored, checked on and visited regularly by a member of the hospital's recently instituted program, Avoiding Readmissions through Collaboration -- ARC for short. The idea is to make sure these high-risk patients don't end up back in a hospital bed because of an avoidable mistake or oversight, such as forgetting to take their medication, or being put on a nutrition plan poorly suited for their needs.

The program, which the hospital began putting together at the beginning of 2011, is now in full swing and making inroads. The hospital has seen a significant drop in its monthly readmission rate since the start of the program, according to Cheryl Reinking, chief nursing officer and chair of ARC.

From January 2011 to November 2013, the hospital's 30-day readmission rate has dropped by close to a third -- from 13.5 percent to 9.25 percent.

"That's a lot," Reinking said. "It's tough to drop your readmission rate that much in just under three years."

The effort has resulted in an estimated 204 fewer readmissions, Reinking said. That has not only saved the hospital money by avoiding treating the same people twice, it's also resulted in financial rewards, as the government penalizes the hospital with a fee for every readmission. Reinking said she estimates the hospital has saved close to $2 million through the ARC program.

The ARC team consists of a geriatric nurse practitioner, an outpatient case manager, a pharmacist, a pharmacy technician, a transitions coordinator and handful of other nurses specializing in cardiovascular care.

The team works in a number of ways to ensure patients remain healthy once they leave the hospital. The geriatric nurse practitioner works closely with skilled nursing facilities to ensure elderly patients going to assisted living facilities have what Reinking called a "warm hand-off" -- making sure the nursing home has a firm grasp on a patient's file and specific needs.

If a high-risk patient is going home after a stay in the hospital, a case manager will be assigned to do home checkups and make sure the patient, and the patient's family, understand what they need to do to stay healthy and recover. The case manager will also often do a walk-through of the patient's home to look out for potential hazards that could impede recovery or land that patient back in the hospital. If a patient is at a lower risk for readmission, phone calls tend to suffice.

The pharmacist on the Reinking's team often functions like a "sleuth" talking to the patient, family members and even calling pharmacies to find out what the patient is taking and making sure none of their medications have negative interactions which might result in a trip back to El Camino. "It's a really key role," Reinking said.

The hospital also wants to keep tabs on the experience of everyone who is treated at El Camino -- from the boy with the broken arm to the woman who had bypass surgery.

El Camino Hospital has contracted with the Ohio-based company, Quality Data Management, which handles calling patients after they've left the hospital and asking them survey questions. The questions are standardized for all hospitals nationwide, Reinking said.

The Hospital Consumer Assessment of Healthcare Providers and Systems -- or HCAHPS -- survey was developed by the Centers for Medicare and Medicaid Services and the Department of Health and Human Services. The survey asks patients a series of questions to assess how a given hospital performed in a variety of areas.

According to the HCAHPS website, the survey asks patients to rate their communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment and transition of care.

The data collected by Quality Data Management allows the Department of Health and Human Services to determine whether and how much El Camino Hospital will be awarded through a system known as value-based purchasing.

Additionally, that data is reported publicly on a website called Hospital Compare. Logging on to hospitalcompare.hhs.gov, anyone can compare up to three hospitals against each another -- looking at a given hospital's results on their HCAHPS surveys; seeing whether patients received "timely and effective care;" and seeing how a hospital ranks in terms of readmissions, complications and death, among other categories.

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