Asking the right questions can help target the real issues causing readmissions

When a patient is readmitted to a behavioral health facility within 30 days of being discharged, there is a regulatory requirement-of both the The Joint Commission and Centers for Medicare and Medicaid Services-to complete an updated psychosocial assessment. The questionnaire that is used is often referred to simply as “the psychosocial.”

If the right questions are asked during the psychosocial assessment, it can mean the difference between success and failure for many patients who are struggling. “Were your family and friends supportive? Did you relapse on alcohol or substances? Were you able to fill your medication prescriptions? Are you homeless?”

Karen Braunwald, PhD, Chief Clinical Officer of Westwood Lodge and Lowell Treatment Center and Director of Lowell Treatment Center, says that the readmission psychosocial assessment that had been in use for many years was cursory and did not provide any specific information about what had precipitated the hospital readmission. She says, “we really did not capture the reasons for the readmission in a useful way. We are trying to prevent readmissions from happening, so having a better understanding of what leads to them can highlight those issues for clinicians during initial hospitalizations.”

As part of revising the readmission questionnaire, Dr. Braunwald reviewed the records of patients who were readmitted within 30 days, as well as relevant research literature, and came up with the most common reasons that contributed to that outcome. The review of these specific issues with patients “is a way to engage patients in thinking about their situation. They can see for themselves that they may be more likely to end up back in the hospital when they stop taking a prescribed medication, for example.” Dr. Braunwald says.

This proactive approach allows staff to provide therapeutic intervention, counseling and referrals for services that can increase the odds that the patient will be successful in following their treatment plan once released. “We can refer them to a community services program that can help facilitate transportation or, as an example, if they are not attending AA meetings, we can encourage them to get a sponsor while they are here in the hospital.”

In addition, new questions were incorporated into the initial psychosocial assessment, done during the first admission, based on input from the UHS corporate risk department. UHS identified issues related to suicide risk that were directly pertinent to common reasons for readmission. Case managers have always done an initial evaluation of new patients within 72 hours of admittance, but now they will have a more targeted, and hopefully more effective, set of questions based on the ability for self-care to get at the very specific needs of each individual.

The revised readmission psychosocial has been in use since January of 2015 and recent data show that readmissions have dropped and are well below the UHS average for both locations. The revised initial assessment was approved at the most recent medical executive committee meeting for use at Westwood Lodge and Lowell Treatment Center and is currently being implemented.
From AHS News, November/December 2015