According to Laviszzo-Maourey (2013), readmissions cost an estimated $26B annually with cardiovascular surgery (CV) readmissions averaging $13,500 (Shah et al., 2019). Preventing one readmission can have a profound impact. Team communication typically occurs in the acute phase, leaving post-acute providers to rely on ER visits and readmissions to manage patient needs.

Ineffective communication contributes to 30-day readmissions (Edelman, 2016). Ambiguous discharge orders, conflicting instructions, and lack of knowledge are areas of concern. The use of video call technology improves communication and possibly eliminates an ER visit that could lead to a readmission. Telehealth fosters a relationship among providers and improves patient satisfaction.

We identified 2 high-volume rehabilitation centers receiving CV surgery patients in 2018 (56%) and 2019 (37%). A guideline for communication was developed for the CV clinic and rehab center. Standardized questions were used. A video monitor and IPAD were installed at both sites. The CV nurse navigator used a report of the previous day’s discharges to coordinate a time for the video call. All calls were initiated within 24-48 hours of transition. This video call conversation included the patient, rehab RN, and CV nurse navigator. Discussions included any patient concerns and process issues with the transition of care. All calls were documented in the EMR and stored in a secure access database.

A total of 144 patients were discharged to the designated rehabs between August 2018 and September 2019. The historical group (n=77) received standard care which involved the CV nurse navigator to rehab RN telephone call using standardized questions. The intervention group (n=67) used video calls to enhance communication between RNs and included the CV patient. Calls for both groups occurred within 48 hours of discharge using standardized questions. Demographics were compared and found to be similar for both groups. The control group had a readmission rate of 23% (n=18) compared to 8.9% (n=6) in the intervention group. Identified clinical issues and patient concerns were addressed and resolved in the moment. Readmission reduction from rehab was achieved when standardized care included video calls. By improving transition communication, video calls increased the comfort level of rehab RNs caring for high-risk CV patients.

Although there was a challenge in coordinating the calls, it was not insurmountable. The time and cost of setting up video calls between the rehabilitation facility and the CV surgery clinic decreased our readmission rate and enhanced our relationship with our community partners, and patients expressed gratitude in the continuity of care.

References
1. Edelman, T. (2016). Reducing hospital readmissions by addressing the causes. Center for Medicare Advocacy. Retrieved from https://www.medicareadvocacy.org/reducing-hospital-readmissions-by-addressing-the-causes/
2. Lavizzo-Maourey, R. (2013, March 14). The Human Face of Hospital Readmissions. [Blog post]. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20130314.029239/full/
3. Shah, R., Zhang, O., Chatterjee, S., Cheema, F., Loor, G., Lemaire, S., …Ghanta, R. (2019). Incidence, cost, and risk factors for readmission after coronary artery bypass grafting. Journal of the Society of Thoracic Surgeons and the Southern Thoracic Surgical Association, 107(6), 1782-1789. doi: https://doi.org/10.1016/j.athoracsur.2018.10.077

Robbin Shifflett RN

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