Prof. Miroslav Harjaček,MD PhD
Prof. Miroslav Harjaček MD PhD

Hospital readmission rates are increasingly used for both quality improvement and cost control. Poor hospital patient safety climate is associated with poorer readmission outcomes.

Hospitals lose a significant amount of revenue due to wasted time and poor communication. Effective communication is critical to successfully implementing new models of care to reduce costs and keep patients from making return trips to the hospital. Hospitals in US waste over $12 billion annually as a result of communication inefficiency among care providers. Increase in length of stay accounts for 53 percent of the annual economic burden. A 500-bed hospital loses over $4 million annually as a result of communication inefficiencies (The Economic and Productivity Impact of IT Security on Healthcare, 2013, Poneman Institute). A Journal of Hospital Medicine study (Kripalani, et. al., 2007), investigating common reasons for 30-day hospital readmissions found that, following discharge, nearly half (49%) of hospitalized patients experience at least 1 medical error in medication continuity, diagnostic workup, or test follow-up, and 19%-23% suffer an adverse event, most commonly an adverse drug event resulting directly from a breakdown in communication.

Poor communication and documentation is leading to a legal liability as found in a closed claims study describing medical errors involving the telephone in patient-clinician encounters that significantly impacted medical care. Medico-legal outcomes in 60 percent of cases reviewed were settled or awarded to the plaintiff, the main reason found in 88% of cases was poor documentation  (Journal of General Internal Medicine, Katz HP et. al. 2008).

These findings point to a need to strengthen efforts to overcome the communication barriers identified to improve patient safety at the interface of hospital, primary care and the home setting.

Interestingly, as found in the recent study, that hospital usage of information technologies (HIT) was not associated with lower hospital readmission rates; however, high levels of electronic documentation (an aspect of HIT use) were associated with modest reductions in readmission for heart failure and pneumonia. On the other hand, improving nurses’ work environments and staffing were found to be more effective interventions for preventing readmissions.