Reducing Hospitalizations, 30-day Unplanned Readmissions and ER visits Quality Improvement Activity (QIA)
The 2020 USRDS Annual Data Report (ADR) Chapter 4: Hospitalizations, Readmissions, Emergency Department Visits and Observation Stats reports patients initiating hemodialysis had a higher rate of hospitalization in the first year followed by a gradual decline, while patient initiating peritoneal dialysis had a lower initial hospitalization rate that increased over the first 3 years and then stabilized.
Decreasing rates of hospitalizations, unplanned 30-day readmissions and emergency department (ED) visits are challenging tasks. Evidence indicates people with unmet social determinants of health (SDH) influence individuals’ ability to attain their full health potential, leading them to consume more health care services or require more intensive health care than those without SDH1. It is also true that people with depression utilize the services of the ED at a higher rate than those without depression.
There are tools and strategies that can be effective at addressing the barriers that underlie these outcomes and it is not easy work. Many of the causes are outside the control of the dialysis clinic, yet we must find a way forward, where possible, using a multipronged approach which includes patient feedback as part of the QIA process. Below are resources and strategies to consider using for this QIA.
QIA Goals and Project Periods
- Goal - 2% reduction for the hospitalization, 30-day unplanned readmissions and ER visits – Project period runs June 1, 2021 - April 1, 2022
- Goal - 5% reduction for patients hospitalized due to COVID-19 - Project period runs June 1, 2021 – April 30, 2022
Facility Resources and Strategies
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CDC: COVID-19 Vaccination Field Guide - 12 Strategies for Your Community - This field guide offers intervention strategies to promote COVID-19 vaccine confidence and uptake based on a rapid assessment of evidence that identified research-proven methods.
- CDC: Disparities in COVID-19-Associated Hospitalizations - Resources to familiarize yourself with topic and strategies to incorporate into your practice.
- IHI 5 Whys RCA tool and instructions (This is quick and easy!) Perform a root cause analysis (RCA) on every hospitalization, 30-day readmission, ER visit and missed treatment and discuss on quality team meeting
- Monthly Chairside IDT Meetings - ESRD Forum approved best practice
- Prevention of hospitalization due to COVID-19 infection
- Post Dialysis Zone Tool - Guidance for healthcare professionals on level of care to provide: monitor is place, seek care from PCP, and go to an ER or urgent care. May be most appropriate to share with nursing homes, SNFs and home health agencies
- Risk Assessment Tools
- HOSPITAL tool – This is an evidence-based, online risk assessment for 30-day unplanned readmissions. It stratifies the patient as a low, intermediate or high risk of readmission. It is also available in Google Play and the App Store: CALCULATE BY QxMD
- Modified LACE tool - This is an evidence-based risk assessment for 30-day unplanned readmissions.
- Screen patients for depression and refer as appropriate. “Patients with a history of depression were more likely to be seen in the ED and have a higher frequency of visits than patients without.” 2
- Screen for social determinants of health (SOD)
- Sit Down-Don't Stand – A needs assessment tool for when your patient returns from the hospital
- SMART Resources
- Transitions of Care Tools
- Work with a local hospital or healthcare system to set up communication to provide dialysis to a patient in a dialysis center who presents in the ER for a treatment
- Find ways to include the patient representative or patients (i.e. what would they find helpful to keep patients out of the hospital or emergency room?)
- Identify a staff coordinator (or two!)
- Improve direct communication with hospital staff prior to discharge
- Use of a dedicated cell phone to receive calls from hospital staff
- Dedicated on-call RN (Use of RN on nocturnal shift?)
Patient Resources
Presentations