Reducing hospital stays

ANN ARBOR, Mich. — A unique University of Michigan Health System program that helps older patients transition from the hospital to sub-acute care facilities has significantly reduced hospital stays and readmissions, according to new findings published in the Journal of the American Medical Directors Association.

Creating seamless patient transfers between hospitals and long-term care facilities has become a growing national concern. Previously reported studies have shown that these patients are particularly vulnerable to medication errors, hospital readmissions and other adverse effects on their care.

The six-year-old UMHS Sub-Acute Care Service – which coordinates care between the hospital and care facilities commonly called nursing homes – has proven a successful model of providing safe transitions for hospitalized patients. The average length of stay at UMHS before transfer to a skilled nursing facility dropped from 10.6 days to eight days, and hospital inpatient stays for patients in the program were reduced by nearly 2,908 days a year, authors say.

The findings come as new Medicare data released this month show that hospital readmission rates are stubbornly stagnant, costing Medicare $17.5 billion in inpatient spending. In October, Medicare will begin to penalize hospitals with higher than expected readmission rates, a mandate of new federal health laws.

The UMHS paper – whose lead author is U-M geriatric physician Darius K. Joshi, M.D.,– appears alongside a JAMDA editorial that lauds the U-M transition program.

“The data presented by Joshi and colleagues are compelling and the program ought to be monitored as a potential model for other health systems,” reads the editorial, titled “Climbing out of the Black Hole of Subacute Care.”

The UMHS sub-acute care program involves a close partnership between UMHS and selected skilled nursing facilities in the Ann Arbor area. It has dramatically changed the relationship between the hospital and facilities by deploying U-M physicians and nurse practitioners to skilled nursing facility partners. This U-M team follows patients after discharge and manages their care on-site.

“These patients are often elderly with chronic illness and other health concerns and require medical care and rehabilitation in skilled nursing facilities after hospitalization,” says Joshi, who is director of the sub-acute program and a clinical instructor in the geriatric medicine division of the U-M Medical School’s Department of Internal Medicine.

“We aimed to break down the silos that are such a big problem in healthcare and improve the continuity of care. We found that an investment like this by a large health system does produce returns by improving the overall quality of coordinated care for patients discharged to care facilities.”

Another critical piece of the sub-acute service is enhanced communication. The slower-paced setting of the care facility grants patients and their families more face time with physicians, whereas conversations may seem “rushed” in hospitals, Joshi says. This helps prevent misunderstandings over patient care.

The UMHS program also coordinates access to electronic health records between the hospital and facility, including inpatient notes, consultant reports, medication lists and allergies to avoid errors that could lead to hospital readmissions. When there is a “bounce back” – a readmission to the hospital from the nursing facility - easy access to data avoids confusion among hospital physicians on why the patient may have returned, the authors note.

“Previously, the post-discharge care off-site was a black hole, invisible and fragmented,” says co-author Tony Denton, executive director of University Hospitals and U-M Hospitals and Health Centers chief operating officer.

“But now, these private nursing facilities are key to safe, timely and coordinated placement of our patients. These carefully selected sub-acute providers are a valuable extension of the excellent care provided inside our hospitals.

“We are bridging communication gaps between the hospital and sub-acute providers, sharing a commitment to quality care.”

Additional Authors: Rick A. Bluhm, J.D.; Preeti N. Malani, M.D., MSJ; Steve Fetyko, MPA, CPA;, JD; Caroline S. Blaum, M.D., M.S. All are of the U-M Health System.

Citation: “The Successful Development of a Sub-Acute Care Service associated with a large academic health system:” doi:10.1016/j.jamda.2012.03.001.