Transitional Care Can Reduce Hospital Readmissions

Joan M. Nelson, DNP, ANP-BC; Amy L. Pulley, BA


Am Nurs Today. 2015;10(4) 

In This Article

Readmission by the Numbers

One in five Medicare enrollees is readmitted to the hospital within 30 days, and up to 75% of these readmissions are preventable. The readmission rate for patients discharged to skilled nursing homes is even higher: 25% are readmitted within 30 days. Such readmissions cost the U.S. healthcare system approximately $17 billion annually, not including readmissions to emergency departments (ED) or urgent-care settings.

The Institute of Medicine (IOM) highlighted this problem in its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century. Yet readmission rates remained stable between 2004 and 2011. The IOM identified poor patient-discharge instructions—including information about medications, red flags for worsening condition, and contact information for questions— as a care-transition problem.