Reducing Hospitalizations, 30-Day Unplanned Readmissions & ER Visits Quality Improvement Activity (QIA)

The 2020 USRDS Annual Data Report (ADR) Chapter 4: Hospitalizations, Readmissions, Emergency Department Visits and Observation Stats reports patients initiating hemodialysis had a higher rate of hospitalization in the first year followed by a gradual decline, while patient initiating peritoneal dialysis had a lower initial hospitalization rate that increased over the first 3 years and then stabilized. 

Decreasing rates of hospitalizations, unplanned 30-day readmissions and emergency department (ED) visits are challenging tasks. Evidence indicates people with unmet social determinants of health (SDH) influence individuals’ ability to attain their full health potential, leading them to consume more health care services or require more intensive health care than those without SDH1.  It is also true that people with depression utilize the services of the ED at a higher rate than those without depression. 

There are tools and strategies that can be effective at addressing the barriers that underlie these outcomes and it is not easy work. Many of the causes are outside the control of the dialysis clinic, yet we must find a way forward, where possible, using a multipronged approach which includes patient feedback as part of the QIA process. Below are resources and strategies to consider using for this QIA.

QIA Goals and Project Periods

• Goal - 2%  reduction for the hospitalization, 30-day unplanned readmissions and ER visits – Project period runs May 1, 2022 - April 30, 2023

• Goal - 5% reduction for patients hospitalized due to COVID-19 - Project period runs May 1, 2022 - April 30, 2023

Linked Facility Resources & Strategies

• CDC: What is Health Equity? - Resources to familiarize yourself with topic and strategies to incorporate into your practice.

• IHI 5 Whys RCA tool and instructions (This is quick and easy!) Perform a root cause analysis (RCA) on every hospitalization, 30-day readmission, ER visit and missed treatment and discuss on quality team meeting

• Prevention of hospitalization due to COVID-19 infection

  • ASN Monoclonal Antibody Therapy  - (for nephrologists)

  • ASN Evidence-Based Practices to Reduce COVID-19 Transmission in Dialysis Facilities

  • Consistent tracking in NHSN of patients’ vaccination status

  • Offer a primary vaccine to unvaccinated patients after new, supportive data is announced (i.e. FDA approval of vaccines, increased longevity of immunity, new local mandates)

    • Pennsylvania Department of Health Coronavirus website

    • Delaware Department of Health Coronavirus website

  • Offer additional dose to the appropriate vaccinated patients

    • CDC-How to Talk to Patients Who are Immunocompromised

    • CDC-How to Strongly Encourage Your Patient to Get an Additional Dose

• Risk Assessment Tools

  • HOSPITAL tool – This is an evidence-based, online risk assessment for 30-day unplanned readmissions. It stratifies the patient as a low, intermediate or high risk of readmission. It is also available in Google Play and the App Store: CALCULATE BY QxMD

  • Screen patients for depression and refer as appropriate. “Patients with a history of depression were more likely to be seen in the ED and have a higher frequency of visits than patients without.” 2 

• SMART Resources

  • How to Set SMART Goals

  • ​SMART Goal Setting to Support Your Kidney Journey

• Transitions of Care Tools

  • The Forum Transitions of Care Toolkit: Chapters 5, 8-10.  Although it was developed for nephrologists caring for transient dialysis patients, many strategies apply to transitions between other care settings.

• Work with a local hospital or healthcare system to set up communication to provide dialysis to a patient in a dialysis center who presents in the ER for a treatment

• Find ways to include the patient representative or patients (i.e. what would they find helpful to keep patients out of the hospital or emergency room?)

• Identify a staff coordinator (or two!)

• Improve direct communication with hospital staff prior to discharge

  • Use of a dedicated cell phone to receive calls from hospital staff

  • Dedicated on-call RN (Use of RN on nocturnal shift?)

Patient Resources

• Reducing Hospitalizations & Unnecessary ER Visits Toolkit

  • Toolkit Instructions

  • Differences Between Your Provider’s Office and the Emergency Department

  • Medical Problem Stoplight Tool

  • Signs & Symptoms of Heart Attack and Stroke

  • Letter for Patient Representatives

  • 10 Reasons to get a Primary Care Provider

• CDC COVID-19 Vaccines for Moderately to Severely Immunocompromised People

• CDC Myths and Facts about COVID-19 Vaccines

• CDC COVID-19 Vaccines Work

• Online Depression Self-Assessment

PDFs of Facility Resources & Strategies

Use the resource library below to download PDFs of available resources. Having trouble with the resource library? Access via this link.