Reducing Hospital Readmissions: 5 Considerations for Discharge

Clinician pushing patient in wheelchair

Occupational therapy has proven to be one of the only spending category in a hospital setting where additional spending has a statistically significant association with lower hospital readmission rates for patients with heart failure, pneumonia, and acute myocardial infarction.1

Hospital readmissions are associated with decreased patient outcomes as well as increased healthcare costs to both patients and healthcare organizations.2 The topic of how to reduce hospital readmissions is constantly being discussed in hospitals and other healthcare organizations across the country. Occupational therapy’s distinct value should be showcased throughout these discussions.

How Is OT Reducing Hospital Readmission?

One possible explanation is that occupational therapy uses a holistic lens that focuses on both internal and external factors impacting a patient’s ability to care for themselves and participate in meaningful occupations.1 Occupational therapists synthesize the medical status, current abilities of a patient, and specifics of their home environment to determine what supports, if any, a patient will need to be successful upon hospital discharge.

The OT Lens

Occupational therapists contribute uniquely to the discharge process as they look at factors that contribute to a patient’s ability to participate in meaningful and necessary tasks, including:

  • Person factors: Patients’ roles, self-concept, cultural background, personality, health, cognition, physical performance, and sensory capabilities
  • Environmental factors: The physical, cultural, institutional, social, and socio-economic environments
  • Occupational factors: The groups of tasks a person engages in to meet their self-maintenance, expression, and fulfillment3

Occupational therapy practitioners use this lens to evaluate, treat, and make discharge recommendations to ensure a holistic picture of the patient’s abilities and environment in relationship to meaningful occupation.

Despite an often short length of hospitalization in the acute care setting, occupational therapy practitioners are often the gatekeepers to OT services in the continuum of care. Not only do occupational therapists recommend discharge locations (such as home, inpatient rehab, or skilled nursing facilities), but they also recommend follow-up therapy services (such as outpatient or home health), safety modifications, and durable medical equipment (such as shower chairs, grab bars, bedside commodes, or walkers) to ensure a safe and effective hospital discharge.

Considerations When Making Discharge Recommendations

Whether you are an occupational therapist or other medical practitioner, using the OT lens can assist you in making discharge recommendations.

Consider the following five questions when making a discharge recommendation.

  1. Does the patient have the physical abilities to care for themselves? This may include but is not limited to:
    • Strength
    • Balance
    • Coordination
    • Range of motion
  2. Does the patient have the cognition abilities to care for themselves? This may include but is not limited to:
    • Orientation
    • Short-term memory
    • Executive function
  3. If the patient does not have the physical or cognitive abilities to care for themselves, do they have the needed social support to ensure they are cared for? This may include but is not limited to:
    • Availability of family and/or friends
    • Outside agencies
  4. Does the patient’s physical environment match their ability levels? This may include but is not limited to:
    • Stairs to enter or navigate the home
    • Bathroom setup, including tub/shower and toilet
    • Distance from the bathroom to bedroom
    • Access to assistive devices, durable medical equipment, or adaptive equipment
  5. How do the above factors impact occupations or activities patients must do? This is the key feature in the OT lens. Occupations often include toileting, getting dressed, showering/bathing, managing medication, preparing and eating meals, and grocery shopping. Using all the information you gathered, consider:
    • What do they need to do to be safe and have a good quality of life?
    • Do they have the above skills or social support to do these activities?

Collaborate with your patient to determine what occupations are meaningful to them.

When patients are admitted to the hospital, they have often undergone physical and cognitive changes, which should be assessed prior to discharge. After answering the above questions, you can determine if a patient needs further in-patient care or if a patient can be discharged home safely with or without additional support. Ensuring a holistic assessment to inform your discharge recommendations not only can decrease readmission health care costs and improve quality of care, but can also increase patient satisfaction.

  1. Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016, September 2). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 1–19.
  2. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine. 2009;360:1418–1428.
  3. Law, M., Cooper, B. A., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9-23