24%
(1,480) Patients Required Intervention
24 Minutes
Median Time to Intervene (Goal: < 2 hours)
Reducing Readmission Rates by 25% Using Post-Discharge Follow-Up
We tried to do discharge calls on our own for many years, and we were not successful. We knew we weren’t moving the needle at all, and that’s when we realized we needed a partner to help us achieve our goals. That’s why we chose Cipher to help us. The ROI on the savings we recouped from this totally pays for this program.
24%
(1,480) Patients Required Intervention
24 Minutes
Median Time to Intervene (Goal: < 2 hours)
BACKGROUND
NMMC has a call back team made up of RNs and staff members who are responsible for following up with any patient who indicates an issue or need during the outreach call. With their inpatient program, every patient receives a general call 48 hours post-discharge. Moreover, patients may be enrolled into multi-call, high-risk outreach programs depending on their primary diagnosis (AMI, CHF, CJR, COPD, pneumonia). These calls include 3-4 outreach attempts over the course of a 30-day readmission period to reach as many patients as possible and help care teams intervene whenpatients need it most.
HIGHLIGHTS
- Patients who were followed up on within 2 hours had a 25% lower readmission rate.
- From 2020 to 2021, NMMC has increased their clinical reach rate from 42% to 53% through increased discharge education.
- Negative response data from the outreach program was used to uncover opportunities such as improving patient comprehension of medication and prescription instructions.
