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Data Collection and Measurement

Next Reply: Re:Tracking re-admits
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Post Tracking re-admits
Author: Deb
Date: Dec 14, 2011 8:05 pm
Hi,
We are looking at tracking hospital readmissions to ID missed referrals. We are trying to come up with criteria to filter the field a little, otherwise we just get all readmissions. Has anyone tried this? What criteria are you using? We hope that we can come up with data on missed opportunities to convince administration and referring docs how we might help further upstream and hopefully prevent some of the re-admits. We are also looking at having a daily report of hospital readmissions (within a specified timeframe), and I will look at chart to ID possible candidates. Thoughts? Experiences? Thanks.
Debbie
Replies: order by [Date] [Author] [Subject]
Re:Tracking re-admits (by Weissman on 12/20/2011)
I've seen different approachesx to this. My recommendation is to pick a defined population where you expect that palliative care should be involved--here are some common elements that could be used to filter patients:

CHF
Aspiriation pneumonia--nursing home admit
Any nursing home readmission
non-chemotherapy admission for cancer where there is a reamit within 30 days

If you succeed in developing a workable model please let me know.

David Weissman, MD
CAPC Consultant
Re:Tracking re-admits (by bishoplr on 02/16/2012)
We are having some success with tracking readmissions of our home care patients across our health system. We use the same ID number for these patients for inpatient and outpatient services to help identify them. We are also having some success with tracking re-admissions of previous inpatient palliative care patients. I could connect you with a colleague to get the details on how this is accomplished; however, we are moving to EPIC from Care Cast EMR software and it may cause a problem with this ability.

Lori Bishop RN, CHPN

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