Why star patients sometimes are readmitted to the hospital

Zuger: Doctors need to consider how patients will fare after discharge

Writing in the New York Times' "Well" blog this week, physician Abigail Zuger explains why a "favorite" patient who receives high-quality, personalized care can be readmitted just days after being discharged.  

The causes of some readmissions are clear, Zuger writes. In some cases, hospitals are at fault, perhaps by failing to provide sufficient instructions for follow-up care. And sometimes patients simply ignore their discharge instructions or resume problematic habits that sent them to the hospital in the first place.

Hospitals in recent years have undertaken broad efforts to avoid preventable readmissions. But some readmissions confound hospital staffs and "torture health policy makers, partly because nobody can quite figure out who is to blame," Zuger writes.

Which hospitals are most likely to face readmission penalties?

Zuger offers the example of a 90-year-old patient considered a "big favorite" among the hospital staff. The patient—who was more pleasant than the patient in the bed next to her—was treated very well in the hospital setting. Staff attended to her many needs, which included adjusting the oxygen tubes in her nose, feeding her, and ensuring that her bed is positioned at the proper angle. Using the metaphor of a theater play, Zuger describes this as "act one" of the patient's episode of care.

"Act two" occurs when the patient returns home. Zuger writes, "Gone is the bed, the oxygen, the bedside tray full of food and ice water. Gone are the professionals, except for a visiting nurse in the wings, and she won't show up until the Monday after the Friday afternoon discharge." The patient "slumps off a teetering stack of old pillows, and from the cutest little thing on a ward full of disasters she becomes a sick old lady lying the wrong way on a bed too far from a bathroom, lipstick smeared, terrifying relatives who don't know how to lift her properly."

AHRQ: The conditions that cause the most readmissions

"Act three"—being readmitted to the hospital just two days later—now appears inevitable.

Zuger concludes that doctors should be wary of how patients appear in the hospital. She writes, "Only by squinting directly at the star of the show until her surroundings blur is there a chance of accurately predicting whether that fabulous performance can be sustained on an empty stage" (Zuger, "Well," New York Times, 6/9). 

A step-by-step guide to preventing readmissions

Check out our Readmission Reduction Toolkit for tips on transition planning during the inpatient stay, discharge education, post-acute care coordination, and transitional care support.


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