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To prevent hospital admissions, gather as much information as possible about the patient's discharge needs, psycho-social needs, and support systems in the community, Cory Sevin, RN, MSN, NP, director with the Institute for Healthcare Improvement advises. Talk to family members and primary care providers who know the patient and can provide first-hand information, Sevin says.
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By placing on-site nurse case managers in hospitals and post-acute facilities, Presbyterian Health Plan of New Mexico has saved more than $1 million in just 10 months, according to Paula Casey, MSN, RN, ONC, CCM, clinical director for inpatient and recovery services at the Albuquerque-based health plan.
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WellPoint's initiatives to reduce hospital readmissions by following up with Medicare Advantage members after discharge has decreased the readmission rate and reduced skilled nursing days, according to Karen Amstutz, MD, vice president and medical director of care management for seniors and state sponsored business for the Indianapolis-headquartered health benefits company.
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The first year after Piedmont Hospital in Atlanta implemented a Heart Failure Resource Center that provides care coordination for patients discharged with heart failure, the 30-day rehospitalization rate for heart failure patients in the program decreased from 4.6% to 1.6% when compared to heart failure patients treated at Piedmont and not in the program.
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As hospitals add more palliative care services, ethical issues arise that sometimes cannot be handled solely by a hospital ethics board because a broader community perspective is necessary.
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Palliative care once was a rare treatment option in the hospital setting, but in recent years it has grown in popularity to the point that most major hospitals and many small-to-mid-sized hospitals have palliative care programs available for patients, an expert says.
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Fresh research on burnout in the medical profession makes it clear that hospital ethics boards need to be proactive on this issue. Their role could include educating and suggesting policies to prevent physician and resident burnout and any resulting repercussions.
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Clinical ethics consultations still are infrequent in most hospitals, but their use is beginning to enter ethics board conversations, and it's an area that should be approached with cautious preparation, an expert says.
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The default policy of many hospitals is to have clinicians perform cardiopulmonary resuscitation (CPR) on dying patients except when there is a do-not-resuscitate (DNR) medical order signed by the patient.
