Navigating the Health Care System

How to Avoid the Round-Trip Visit to the Hospital

By Carolyn M. Clancy, M.D.

June 1, 2010

When patients get out of the hospital, it's usually a sign that their health is getting better and they're ready to recover at home. Unfortunately, millions of patients each year end up back in the hospital. In fact, 1 in 5 Medicare patients go back within 1 month of being released. Even more people face unexpected medical problems within weeks of leaving the hospital.

Many of the medical problems that send patients back to the hospital could have been avoided in the first place. What causes these problems to happen?

Often it's because patients and caregivers don't understand what they need to do to take care of themselves or their loved one after a hospital stay. No one at the hospital told them exactly what they should and shouldn't do at home or answered questions on taking medicines, making followup appointments, or arranging for followup tests. Research sponsored by my agency, the Agency for Healthcare Research and Quality (AHRQ), found that more than one-third of the patients who leave the hospital don't get the followup care they need like lab tests or a referral to see a doctor who specializes in their condition.

Sometimes problems occur because patients are excited about leaving the hospital and don't take time to ask questions about the information they get as they're leaving.

The good news is that efforts are being made to make sure that patients—and family members—get and understand the information they need before they leave the hospital.

Educating patients about their medicines before they leave the hospital is a 2010 patient safety goal from the Joint Commission, a national group that accredits hospitals (PDF File; Plugin Software Help). Medicare has also stopped paying hospitals for additional costs that result when certain preventable conditions cause patients to end up back in the hospital. Recently, AHRQ developed a new resource to get patients better prepared to leave the hospital. Taking Care of Myself: A Guide for When I Leave the Hospital is a guide that highlights what patients need to know when they leave the hospital.

The guide is based on pioneering work done at Boston University Medical Center. Through a program called Project RED, doctors and nurses at the facility changed the way patients are discharged from the hospital. Funded by AHRQ, Project RED uses trained nurses to help patients understand their condition, make followup appointments, and confirm which medicines they should take. A pharmacist also contacts patients 2 to 4 days after they leave the hospital to answer any questions they may have about their medicines.

Patients who took part in the program were 30 percent less likely to have a second hospital stay or go to the emergency department than patients who did not participate.

The same simple, but important, steps that helped these patients can help you or your loved one. These steps, outlined in the new guide, include:

• Making an appointment to see your doctor or a specialist who treats your condition.
• Taking your medicines correctly.
• Making sure you aren't allergic to any of your medicines.
• Asking your doctor about your test results.
• Getting the right kind of exercise.
• Knowing who to call with questions or problems.

The easy-to-understand guide helps you keep track of this information and gives you space to write down any questions you want to ask during future appointments.

Of course, this information won't prevent you from going back to the hospital if you have a bad reaction to a medicine or if you need more treatment. But it does increase the chance that you'll be better prepared to take care of yourself when you leave the hospital. This can help prevent a return visit and save you time, money, and stress.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
Care Transitions—What You Need to Know (Transcript)  Podcast Help

Agency for Healthcare Research and Quality
Taking Care of Myself: A Guide for When I Leave the Hospital
http://www.ahrq.gov/qual/goinghomeguide.htm

Boston Medical Center
Project RED (Re-Engineered Discharge)
http://www.bu.edu/fammed/projectred/index.html 

Current as of June 2010

Internet Citation:

How to Avoid the Round-Trip Visit to the Hospital. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, June 1, 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc060110.htm