Hospital Readmissions - A Tale From Two Sides

I am currently working with a project to reduce readmission rates from the acute surgical care clinic at the hospital associated with my medical school. It is a fascinating project and problem - one that can really be seen from many different angles. The question of why people are readmitted to the hospital following discharge has so many potential answers:

• poor discharge education
• lack of access to primary care
• inability to get medications
• misunderstanding of medications and conditions
• non-adherence to lifestyle change

The list just keeps going. And so much of this we put on ourselves in healthcare. I didn't teach the patient well enough. I didn't support them in their efforts to get a primary care. I really should have been more sensitive to their cultural needs. We really like to blame ourselves, and there is nothing wrong with that. We can only improve where we see a problem. And up to this point I put the onus on the provider to reduce hospital readmissions. If a patient is readmitted it can be directly traced back to a fault of the healthcare provider. It is something that we in healthcare can and should prevent.

But the world just isn't that black and white....

Lately my aunt has been in and out of the hospital almost every two weeks with a CHF exacerbation. She gets fluid overloaded and gets readmitted, diuresed, and discharged with medications changed. The nurse explains everything to my aunt and my family. My family understands these directions and asks all the right questions. I am not the first one to go into healthcare here. She takes her medications religiously, has stopped adding salt to all of her food, has no problem getting to doctor's appointments. And yet she still enters the hospital every other week. Is this a fault of the system? Is she getting substandard care? Can I really blame her healthcare team for a fault that seems to be the disease?

The med student in me says that hospital readmissions can be reduced down to practically nothing. Now watching my aunt, I question that long held belief.