Abstract
Purpose of Project: The purpose of this quality improvement project was to reduce 30-day readmission rates to inpatient psychiatric hospitals by standardizing discharge processes by including scheduling outpatient psychiatric appointments for all patients at discharge and also to include the mailing postal reminders to prompt patients to attend their first outpatient mental health appointment following treatment.
Primary Practice Setting: Inpatient psychiatric hospital.
Methodology and Sample: The project design was an analysis of readmission data obtained both 3 months before and after implementation of the postal reminder letters. This project took place at a 50-bed inpatient psychiatric hospital in the southeastern United States that accepts male and female adult patients with mental health and substance abuse disorders.
Results: The implementation of an appointment reminder letter resulted in a slight decrease in 30-day readmission rates. The average readmission rate 3 months prior to implementation was 10%. The average readmission rate 3 months postdischarge was 9%. December 2015 was included in the postimplementation data. December historically has higher rates of 30-day readmissions at this facility. If this month had been excluded, more dramatic decrease in 30-day readmission rates could be observed.
Implications for Case Management Practice: Future implications for case management practice could include the usage of reminder prompts via telephone communication or text messaging in conjunction with postal reminders. The psychiatric population can be particularly challenging when considering increased risk for readmission within 30 days and also the impending pay-for-performance quality measures, which are soon to be implemented. Measures should be taken now to ensure that readmission rates decrease, not only to promote better patient outcomes, but also as a cost-saving measure. Although many variables may contribute to the risk for 30-day readmission rates including medication noncompliance, lack of proper follow-up, as well as seasonal trends, the postal appointment reminder letters may further decrease 30-day readmission rates. Other care management strategies combined with reminder letters may further address barriers that may exist to not only improve patient outcomes, but also to further reduce readmission rates. It is also important to mention that there are further implications that could be directly contributed to specific social determinants of health specific to the psychiatric population. For example, access to prescribed medications and transportation to appointments should be addressed to further reduce readmission rates for this vulnerable population.