Implementing a Transitional Care Protocol to Reduce Psychiatric Rehospitalizations

Readmission rates in hospitals across the country are at an all-time high. Patients beingdischarged from the hospital may feel fearful, especially if they are experiencing a new onset ofillness. Many patients wonder how they will deal with or manage their illness once they returnhome. The goal for hospitals should be to reduce readmissions by addressing the factors thatimpact readmission. Improved care coordination is one of the goals of transitional care. Patients'functioning and quality of life increase when hospital readmissions are reduced. Readmissionscan be reduced by addressing care management before and after discharge in all care settings.The purpose of this quality improvement (QI) project was to implement transitionalinterventions for patients in the psychiatric department to reduce rehospitalization rates. Thestudy's objectives were improved patient safety and health outcomes, ensuring that the transitioncare program produces positive results. The QI project was implemented in an adult psychiatricunit of an acute care hospital. The psychiatric unit has 37-beds, treating patients from differentwalks of life and genders. The most common patient diagnoses include bipolar illness,depression, anxiety, schizophrenia, and substance abuse disorders.The project's goal was to have a transitional care protocol completely implemented withthe aim to reduce 30-day readmission rates by 20%. The transition care model (TCM) usedduring the discharge process was intended to coordinate care and offer timely communication,both of which are important in avoiding readmission. In the pre-implementation stage,readmission rates were relatively high (75%). Following the implementation of this protocol, 80patients in the post-implementation group were contacted for a follow-up call following theirrecent discharge. After 30 days of follow-up, 13 patients had been readmitted back to theinpatient psychiatry unit or other local units. In the pre-implementation group, there were 60 (75%) readmissions and 20 (25%) non-readmissions. In the post-implementation group, therewas a reduction in readmissions, 13 (16.3%). This reduction was statistically significanthighlighting the effectiveness of the TCM model.TCM has also evidenced to minimize emergency department visits, rehospitalizations,and hospital costs. TCM focuses on transitioning high-risk patients from the hospital to theirhomes. TCM involves thorough assessment and planning before discharge, as well as homefollow-up. The transitional care model's efficacy was demonstrated by the findings of thisproject. The proportion of readmissions decreased significantly from before to after the protocolwas implemented.