BOOSTing Outcomes for Older Adults
In 2008, SVMC was selected by the Society of Hospital Medicine to participate with five other hospitals across the country to improve care of older patients as they transition from the hospital or home to another care facility. Known as Project BOOST (Better Outcomes for Older adults through Safe Transitions), the goal of this national demonstration project was to reduce hospital readmissions by improving the inpatient discharge planning process. The project began in the fall of 2008 and concluded in late 2009.
When the project was initiated in 2008, SVMC had an overall unadjusted readmission rate of 12%. Further, statewide report card data showed that residents in Bennington County were more likely to be hospitalized for angina, chronic-obstructive pulmonary disease, congestive heart failure, and pneumonia than residents in other counties around the state. Research shows that effective and timely outpatient care can help avoid serious complications that lead to the need for re-hospitalization. SVMC selected this project to improve the hospital’s discharge process for adults with respiratory disease to ensure better outpatient care. The goal was to reduce the number of patients readmitted to the hospital within 30 days of discharge from 12% to 8%. Other targets included improved physician satisfaction with the inpatient discharge process, improve coordination of care with the patient’s primary physician and improved medication reconciliation upon discharge.
The team found that the overall discharge process was non-standardized, cumbersome for caregivers and did not ensure patients would receive appropriate follow-up once they left the hospital. As a result, patients did not have a good understanding of how to manage their disease effectively, and their primary care physicians had no knowledge of their hospitalization for appropriate follow-up.
To address these issues, the BOOST team improved patient education regarding their post-hospital care, developed a process to schedule patient appointments with their primary care physician before patients are discharged, and created a packet to give to patients detailing instructions for home care, medications to take, post-hospital follow-up appointments and new prescriptions to be filled and taken. The hospital attending physician give the patient’s primary physician a discharge hand-off, outlining the hospital course, medication changes and test results pending. The hand-off assures the primary care physician had the information needed to effectively manage the patient’s disease and recovery after hospitalization. A nurse will also call the patient the day after discharge to make sure the patient is taking his or her post-discharge medications and is able to follow up on the appointment with his or her primary care physician.
These interventions were put into place in March 2010. The hospital will be looking at its 30-day readmission rate and patient satisfaction with their discharge beginning in June 2010 to determine the effectiveness of the improvements. To date, both patients and providers are reporting improvements in pain and symptom management.