Hospital readmission rates and adverse drug reactions after a patient is discharged from the hospital are significant problems, according to Yale-New Haven physician researcher Dr. Leora Horwitz.
In a study by Dr. Horwitz, 81 percent of 377 patients at Yale-New Haven Hospital who were admitted for heart failure, acute coronary syndrome, or pneumonia had problems after discharge either with:
- Provider error in medications prescribed
- Patient confusion about at least one of their medication changes
The study showed that provider error caused 24 percent of the medication changes. Also, in general, patients had “no understanding of all stopped, re-dosed, and new medications.”
“We’re talking about the vast majority of our patients going home at potential risk,” of medication problems, Dr. Horwitz told the Connecticut Health Investigative Team. “That’s huge. Collectively something is not right.”
The problems have two main causes, according to Dr. Horwitz. One is the result of the way the electronic medical records systems are set up at hospitals. The other problem is poor or no patient understanding of their post-discharge medications.
To address the first problem, electronic record systems, Yale-New Haven expects to begin a new program in February that will make it possible to track detailed records of medication prescriptions.
The second problem needs to be addressed with better patient education. When a nurse goes over the patient’s medication regimen at discharge, according to Dr. Horwitz, the patient usually forgets the instructions before reaching home. Patients need to be informed about their medications “over the course of” the time that they’re in the hospital so that the health care professionals can determine how well patients understand the medications and why they’re being used.
The federal government also is stepping in to pressure hospitals and staff to deal with these problems, which lead to many hospital readmissions. The government is going to trim Medicare reimbursement to hospitals that readmit patients for pneumonia, heart attacks, and heart failure. Yale-New Haven is among 23 hospitals in Connecticut that face these penalties and 2,200 across the country that will be penalized for high readmission rates.
Something else Dr. Horwitz’s study found is that readmissions for medication errors are for conditions other than those the patients were hospitalized for in the first instance. This means the hospital staff needs to do better at managing patients’ chronic diseases, she said.
Yale-New Haven and its affiliated hospital St. Raphael are working with the Agency on Aging of South Central Connecticut, along with a number of other hospitals in the region, at improving the transition for Medicare patients returning home after hospitalization. The program is directed by Connecticut Community Care, Inc., of Bristol.
The other hospitals participating in the program are Bristol Hospital, Hartford Hospital, John Dempsey Hospital, Lawrence & Memorial Hospital, Mid-State Medical Center, Saint Francis Hospital and Medical Center, the Hospital of Central Connecticut, William W. Backus Hospital and Windham Hospital.
Source: Connecticut Heath I-Team
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