Lowering the risk for high-risk readmissions

Patient with nurseCook Children’s readmission data indicated that a primary diagnosis of mood disorder, not otherwise specified was the third most common readmission diagnosis. As a result, the psychiatric nurse case manager role was created to identify readmission risk, decrease psychiatric readmissions and improve patient outcomes.

We know that psychiatric readmissions are traumatic and costly to patients and families. With the introduction of the All Patient Refined-Diagnostic Related Groups (APR-DRGs) to pediatric hospitals, we anticipated further limitations to reimbursement. Thus, we addressed readmissions proactively through the creation of a post-discharge nurse case manager position. Although discharge planning during an inpatient stay is standard practice, predicting readmission risk and assisting families post-discharge is a novel and relatively unexplored approach in psychiatry.

When the nurse case manager started in July 2014, her role was to provide post-discharge telephone calls to assist families with their connection to community providers and transition from hospital to home and school. After a review of literature regarding contributing factors of readmissions, a readmit predictor tool and protocol (which is now copyrighted) was created for the electronic medical record. Next, a database was developed to evaluate readmissions prior and subsequent to the new position. Another database that the nurse case manager utilizes is a spreadsheet for recording contacts with patients’ families. An additional intervention developed is regular emails for which families can sign a release to receive. These emails offer parenting tips and reminders of our free support groups. Finally, the nurse case manager provides coordinated care between psychiatrists, therapists, community organizations and Cook Children’s nursing staff, which is improving job satisfaction among our staff.

Quantitatively, preliminary findings have shown a decrease of 29% on readmissions less than 30 days post-discharge. In addition to the decrease in readmission rate, another unexpected finding was that we found an increase in staff morale related to the feedback the case manager was able to provide to our psychiatry team. Normally we do not hear if a patient and family are doing well after discharge because we do not have communication with them. Thus, this encouraged our staff to know that much of their work does come to fruition.

This innovative role focused on post-discharge care is effective as a quality initiative and a cost reduction intervention for patients and hospitals.