Enhanced recovery pathways can lower re-admission rates

As part of a series of major reforms within the United Kingdom public sector, hospitals will soon be penalised financially if patients have to be readmitted within 30 days after discharge from hospital. Click here for full story

The good news for hospitals is that enhanced recovery pathways can help to keep re-admission rates low. The misconception with enhanced recovery pathways is that because patients go home sooner there is more chance of them being re-admitted. This is not the case. In our experience, there is no change to case-mix adjusted re-admission rates, and many units actually reduce their re-admission rates after employing an enhanced recovery pathway. Our graph presented at the International Forum for Quality and Safety in Healthcare earlier this year clearly shows this.

Re-admission rates are kept low because the pre-operative processes in enhanced recovery pathways prepare the patient for discharge before they come into hospital for their operation. The pathways are also highly organised, and so potential difficulties for discharge are always flagged up at the pre-operative stage and arrangements made ahead of time.

Patients expectation is managed and so the patient will have prepared thoroughly for going home. Enhanced recovery patients in the exemplar units will receive a post-discharge phone call at 24-48 hours, and have a hotline number to call the unit directly if they have any problems once they are home. Patients will also go home with an excellent understanding of what activities and exercises to do.

Enhanced recovery pathways also prepare patients for home by promoting a “wellness model” of care rather than an “illness model” throughout the pathway. Independence is promoted at every opportunity so that the patient is prepared to cope once they leave the hospital environment. Examples of this include early mobilisation, getting dressed in regular clothing on the first post-operative day, self medicating, and completing exercises independently.