Hospitals in pursuit of excellence

20 Percent Reduction in All-cause Readmissions

The project began with a focus on CHF readmissions. As the multidisciplinary team saw decreases in those readmissions, the health center realized the positive effect they were having on all-cause readmissions as well. They then shifted their focus to all-cause readmissions. The organization's goal began with a 20% reduction in CHF readmissions and then became a 10 percent reduction in all-cause readmissions. They have also set a stretch goal of a 20 percent decrease in all-cause readmissions in line with the IHA HEN initiatives. A full time outpatient case manager makes discharge phone calls, sets up follow-up appointments and conducts home visits for high-risk, high-need patients. The pharmacy has become very active with the med rec process at both admission and discharge, including inpatient patient education. They have implemented a patient advisory council to engage their patients and families and to include them as active participants in the health care team. The multidisciplinary approach allows us to address multiple readmission risks and patient specific needs.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state.  These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)