2022 CASE MANAGEMENT PRACTICE IMPROVEMENT AWARD

PROJECT TITLE: Readmission Prevention of Patients Discharging with COVID-19

RECIPIENT: Kaiser Permanente of Washington

CATEGORY: Readmission Prevention

ABSTRACT: The COVID-19 pandemic may be in everyone’s rearview mirror, but that period taught the healthcare industry many lessons. How care was facilitated and delivered changed rapidly. Kaiser Permanente Washington (KPW) decreased readmission rates for patients treated for COVID-19 pneumonia. Many patients were discharged on oxygen and were at high risk for readmission. KPW developed a post-discharge follow-up program that greatly reduced the risk of readmission.

Patients treated for COVID-19 pneumonia and discharged on oxygen were closely followed by a case manager. Patients were contacted 48 hours after discharge and received five additional calls. The case managers monitored their symptoms and oxygen usage, providing education and support, like when to call their physician.

RESULTS / OUTCOMES: The readmission rate between 2020 and 2021 was only 1% as a result of this new process. The estimated cost savings was $11,375,000. Due to the success of this process, KPW has continued the post-discharge follow-up post-COVID.

Program Article

COVID-19: Impacting Hospital Readmission with Focused Care Transition Calls, Kathleen Parry, BSN, RN, CCM,

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READMISSION PREVENTION OF PATIENT DISCHARGING WITH COVID-19. Over two years, hospital admissions were dominated with patients presenting a primary diagnosis of COVID-19 pneumonia with hypoxia. These patients had an increased risk of readmissions. During today’s session, you will hear how one organization implemented new interventions to decrease return visits by adding closer follow-up upon discharge. They were able to provide earlier follow-up to identify transitions that were not effective and provide a level of care to provide necessary resources.This organization will share how they were able to support the primary care time while innovatively identifying ways to support patients and reduce readmissions. You will also learn how you can identify processes improvements in your organization and create the data for measuring your outcomes. These helpful tips can help your organization demonstrate process improvement, savings, and justification for case management services.

PRESENTER: Kathleen Parry, BSN, RN, CCM