I. E. McElroy1, H. Wu1, E. Gee1, N. Satou1, R. Shemin1, P. Benharash1 1University Of California – Los Angeles,Cardiac Surgery,Los Angeles, CA, USA
Introduction:
Readmission rates after surgery have become commonly-used surrogate markers for quality of care. The Affordable Care Act mandates Medicare to penalize hospitals with “excessive” readmissions for diagnoses including myocardial infarction and heart failure. Beginning in 2015, the penalty will increase to three percent and will encompass more surgical diagnoses including coronary artery bypass grafting (CABG). Because cardiac surgical patients are at a higher risk of readmission due to comorbidities as well as surgical complications, we hypothesized that a multifaceted readmissions reduction initiative (RRI) would reduce the rate of unplanned hospitalization at our institution.
Methods:
Starting in March 2014, we implemented a RRP consisting of post-discharge follow-up phone calls, formal education about postoperative care, and coordination of post-discharge care by creation of appointments before discharge. Using our institutional Society of Thoracic Surgeon’s database, we compared readmission rates between two cohorts: patients discharged prior to institution of the program (NRPP) and those discharged after (RPP). Patients in the RRP group were further categorized as high risk for readmission if they had greater than four risks factors identified by the California CABG Outcomes Reporting Program. High risk patients were contacted via telephone within 72 hours of discharge. If the calls lead to an intervention that prevented a readmission, the action was recorded.
Results:
During the study period, a total of 164 (NRPP=51) CABG operations were performed with successful discharge, 25 (15%) of whom were readmitted within 30-days. The baseline characteristics (Table 1) and readmission rates did not significantly differ between the groups (RPP 15.6%, NRPP 15%, P>0.5). Of the 113 RPP patients, 65 (57%) were identified as high risk and received follow-up phone calls (66% successful calls), leading to seven interventions and five readmission preventions. Despite a significantly different calculated risk, no difference in readmission was seen between the high and normal risk subgroup (high=12%, normal=13%, P=0.93).
Conclusion:
We postulated that a program that would educate patients about postoperative care, coordination of post-discharge care, and targeted phone calls after discharge would reduce the rates of readmission after CABG. While the RRI was successful in reducing readmission rates, addition of follow-up phone calls did not seem to significantly affect outcome. Major barriers including staffing and inability to communicate with patients existed and may have contributed to the apparent lack of efficacy. Healthcare organizations should carefully consider the true benefits of individual readmission reduction programs before permanent implantation.