BEFORE JC. has the second highest rate of readmission to hospital in Canada; elusive solutions

] BC Medical experts call for concerted effort to improve readmission rates in hospitals after report that province has second highest rate in Canada

Readmission rates in hospitals have become the primary indicator of performance of the health system. . When they are relatively high, as in the case of CB, they are an indicator of "suboptimal health system performance", a recent report in BC The Medical Journal says

There are many risks to patients returning to the hospital, not to mention higher costs for the health system.

In British Columbia, 9.6% of hospitalized patients leave the hospital over the next 30 days, often through emergency services, due to procedural complications. or infections, falls, blood clots, adverse drug reactions and pressure ulcers. The national average for unplanned re-admissions to the hospital is 9.1%. The province with the highest rate was Saskatchewan

Readmitted patients tripled their mortality rate during the year following discharge, compared with patients who stay at home after being discharged from school. 39; hospital. Some 25 to 50% of hospital readmissions are retrospectively judged avoidable, but "effective and targeted interventions to prevent them from remaining evasive," according to the CA. Medical Review Report by Internal Medicine Experts at the University of BC In British Columbia, hospitalized patients for serious medical problems like mental health issues, incurable diseases such as cancer, inadequacy Cardiac and Chronic Obstructive Pulmonary Disease (COPD) are the most likely to be readmitted (15%). operated patients (8%) and children under 19 years (7%). Only two percent of patients are readmitted within one month of discharge.

"Patients are often vulnerable and frail when they leave the hospital," said Dr. John Staples, a Vancouver internal medicine specialist who co-authored the journal's review of readmissions. According to Staples, the patients who seem to come back most often are men, the elderly, people with multiple illnesses, poor people and people who have been hospitalized or not in the last six months. In the current Quality Management in Healthcare review, Staples and its co-authors show that in a group of patients at the Vancouver General Hospital, the most common causes of preventable readmissions were inadequate coordination of community services after leave, poor clinical supervision after discharge. suboptimal end-of-life care.

Staples says there is no scientific answer explaining why men are more likely than women to be readmitted. "But I could make some badumptions: men are less likely to adhere to their recommended treatment and they seem to be more cavalier on health issues like COPD."

Doctors do their best to "succeed Patients "on discharge from the hospital." When patients have complex medical problems, Staples said that to minimize the risk of being readmitted, patients and their family members should be "safe." ensure to receive a discharge report summarizing the diagnosis, treatment and other recommendations for follow-up care.If this is not ready for discharge, patients should come back and get it when he is ready.They should also see their primary care provider after they leave and have a plan for home care or other community services required, said Staples, who works at St. Paul's Hospital. and in Van General

an exit summary of their last hospitalization and a list of medications so that, they go back to the hospital, especially if it 's d & # 39; another, they can share this information with the next medical team.

The report of the medical journal shows that many hospitals with higher readmissions are small and in rural or remote areas; at Bella Coola it is 16% and at McBride 18%. There are exceptions, such as Port McNeill, which has an incredibly low readmission rate – only four per cent. Staples said that small hospitals face unique challenges, like few medical specialists.

In an ongoing experiment in BC, hundreds of patients with congestive heart failure are provided for two months with remote monitoring equipment that collects biometric measurements. The TEC4Home study aims to determine whether unnecessary emergency room visits can be reduced when new patients take their blood pressure, weight and oxygen saturation levels and then share them with the nurses who review the data and contact the patients. doctors to determine if medications are changing are necessary.

Jane Grafton, a Surrey resident who took part in the trial when she started last year, said she was hospitalized six times in the last four years, but after the last stay, she was registered at the trial. Using the digital instruments that were provided was a telling experience.

"It was brilliant because it helped me see what was going on. I could control my liquids, the food I ate and my weight, "said Grafton, 74, who, in addition to heart failure, suffers from COPD and diabetes.

The TEC4Home Trial is an example of "Remote Monitoring Test exploring innovations that may help reduce readmissions to the hospital, but a concerted effort is needed by physicians, hospital administrators and the government to fight the problem, said Staples.

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