Reducing Infectious Diseases Readmissions - How It Is Done

Infectious Disease readmissions are a major problem for healthcare systems.   With the increased scrutiny for readmissions anything a healthsystem can do to reduce readmissions for infection problems is of great interest.  Of particular note pneumonia is the number 1 cause of readmission to hospitals.  Septicemia is the 5th most common but represents the most costly cause of readmission.

There has been a lot of emphasis on cardiovascular diseases as a cause for readmission with a lot of successful efforts to limit those through outreach to the venues of care after hospitalization whether in the home or the skilled nursing facility to implement processes that address reasons for readmission - medication management and timely follow up among the most important.  

There is less standardization for action designed to reduce readmission for infection.  In part this is related to the absence of an accountability formula for a physician  responsible for evaluation of risks and predispositions to infection.   It is also related to the absence of a coordinated process of care for early identification and management of infection related illness to prevent re-admission and keep people safe. Furthermore, infections after a recent hospitalization can be very random making prediction hard.  Since infections are not organ specific these issues can only be addressed and lead by an infectious disease clinician skilled in these concepts.   In the absence of this leadership any program put in place to address this concern runs the risks of over-utilization of tests and antimicrobial medications with the attendant costs and complications this brings.  Most notable are the concerns for multi-drug resistant organism infections and Clostridium difficile infection.  

A well coordinated plan to address infectious diseases diagnosis as a cause for readmission can be readily implemented in a skilled nursing facility by an infectious diseases physician led team at the facility which develops a global process to address this concern.   The process starts with a risk stratification to identify those individuals with the highest risk for the most common infectious diseases readmission causes.   For example, people with recent strokes or other central nervous system disorders that run the risk for pneumonia.   Individuals with multiple comorbidities who received prior antibiotic therapy and now have risk for Clostridium difficile.  Patients admitted from a hospital where they had a prolonged time with a foley catheter putting them at risk for a urinary tract infection, and possibly even septicemia because of urine retention.   Patients with a prolonged hospital stay with multiple indwelling intravenous lines maybe a greater risk for bacteremia.   Patients with newly placed devices such as pacemakers, defibrillators, prosthetic joints and other devices are at risk for surgical site infections.  

Staff education for early signs and symptoms of infection with prompt engagement of the infection treatment team to provide proper guidance is the next important key point.    Proper culture, proper testing and proper use of early interventions to treat the most likely problems will limit the chance of deterioration to a the point of needing admission and reduce complications from over testing or over treating.  Use of point of care testing to properly assess risk can be an important part of this management.

With these steps SNF can reduce their readmissions to their partner hospitals.