Lest They Forget: Family Key to Reducing Hospital Readmissions
By Jennifer Larson, contributor
Even the best after care plans can fail if a patient is forgetful or may become confused. But one way that nurses can help patients after they leave the hospital is by collaborating with their family members before discharge.
A new study conducted by researchers at Henry Ford Hospital in Detroit found that working with family members of patients with cognitive impairment reduced the chances that the patients would need to be readmitted to the hospital.
The study, published online in the American Journal of Accountable Care on January 25, 2016, studied the effectiveness of a family intervention strategy with patients with congestive heart failure.
“Cognitive impairment is highly prevalent in patients with chronic illnesses identified as having high readmission rates by (the Centers for Medicare and Medicaid Services),” the researchers wrote. And yet, “recognition rates for CI by medical practitioners have been documented to be astonishingly poor, averaging about 10 percent to 20 percent.”
It’s “unconscionable” that it’s so uncommon to assess high-risk patients for cognitive impairment before discharging them, said clinical health psychologist Mark Ketterer, PhD, the study’s lead author.
In fact, families can sometimes be oblivious to the signs of cognitive impairment in their loved ones. Using a screening tool like the widely adopted Mini-Cog test, which was used in this study, can make the situation clearer to them. The test creates an opportunity to discuss future care for their family member.
“It’s a question of good care,” Ketterer said.
In this study, patients with congestive heart failure were assessed for cognitive impairment (CI) after they were admitted to the hospital. Then, researchers approached them with the possibility of participating in a program described as helping them “stay healthy and out of the hospital.” If the patient met certain criteria, the team offered the patients and families the chance for education about CI and how they could help their affected family members.
The researchers found a significant decrease in 30-day hospital readmissions among the patients who were assessed for CI (including their psychosocial history and their baseline mental state) and whose families were invited to participate as collaborators.
As health care professionals who spend the most time with patients, nurses can make a big difference, even if their hospitals don’t have a standardized procedure for determining risk or assessing the severity of cognitive impairment in hospitalized patients.
Ketterer’s advice for nurses caring for patients who might have CI:
Observe carefully. If you’re working with a patient who has or is at elevated risk for cognitive impairment, be especially vigilant when observing him. Does the patient remember that the medical team rounded on him two hours ago? Does he remember that he’s scheduled to undergo a test later today? Don’t shrug off what Ketterer calls “soft signs.” “They mean something,” he said. “They mean the patient isn’t processing information properly.”
Listen to the family. The family members typically see the patient over time and notice things. They might make offhanded comments that should make your ears perk up, like, “We don’t let him pay his bills anymore.” They might not realize that what they’re observing is a sign of cognitive impairment or dementia, but it often is.
Don’t stay silent. If the patient has returned to what’s considered his “baseline” but is still displaying signs of forgetfulness, don’t brush it off. “They should bring that to the attention of the medical team,” said Ketterer. “The doctors need to know that.”
Keep the team posted about the family’s concerns. If the patient’s family member or loved one expresses concern about the patient’s mental state, be sure to let the rest of the team know. It might fill in some gaps about the patient’s situation, as well as raise some questions about how to prepare the family for the care that the patient will need after discharge.
Related articles:
How to Communicate with Patients of All Generations
Addressing Social Factors in Your Patients’ Health
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