Performance Improvement Tip of the Day: Readmissions Assessment Tool

Systematically assessing high-risk patients who are readmitted to a hospital is one of the proven strategies to reducing readmissions. 

The keys to implementing this tool are: discipline and structure.

Staff tend to think that "we already address all of these issues with our patients". However, if it doesn't done with discipline, its not happening reliably, and that will allow for some vulnerable patients to fall through the cracks. This form can provide structure to the readmission assessment process, and increase confidence that any issues that can be acted upon are being identified.

Structure is provided through the actions indicated by the next steps listed next to each element of the assessment. The point here is simple but very important to grasp - assessment without intervention is meaningless. This is not a data collection task, but an opportunity for improvement. 

This form is a variant of a checklist integrated with a decision support tool: it reminds the user of specific issues that need to be addressed, and provides clarity as to the decisions that should be made if any items are "checked". Intelligent tool design is critical to getting a tool in use and for driving performance.

This Readmissions Assessment Tool was modified from a version being used by participants in the STAAR (State Action for Avoidable Readmissions) Initiative supported by IHI (Institute for Healthcare Improvement) and The Commonwealth Fund.