I just started hearing that stupid brake squeal from the front of my 10-year old truck…again! The new brake components installed a few months ago were to replace the new brake components installed a few months before that.  I suppose I will have to go BACK IN in order to sell this pretty nice looking, but pig-sounding, truck.

Returning your human body back to the hospital is probably even more irritating.  Did “they” do something wrong? Did you?  Did both? We might decide the “bounce-back” is no one’s problem.  This might be the nicey-nice route, but now there is no incentive on your part or their part to do anything different (i.e., it will happen again).

Reducing readmissions is a key part of health reform and many quality efforts.  Bob Wachter (of Wachter’s World), has a pretty clear discussion of this at his Blog.

Question:  Can we reduce discharge “bounce-backs” with huge computer systems, 85 million pseudo-checklists, and a pile of brussel sprouts (think sulphury tasting carrots)?  I am not sure…

My wife has been discharged from same day and overnight hospital stays many times in the past few years.  What did the healthcare staff do to keep the complications from medical procedures and strong medications from pushing her back into the hospital?  I will save that for her to describe in specific detail another day.

Overall, however, the main tools to tell us how to avoid “bounce-back” were verbal instructions (doc), verbal instructions (nurse), written instructions (standard-printed), written instructions (hand-written), and whatever was printed on the medical items (bandages) or meds we were given.  Oh, and whatever was left over in my head from medical school-residency 25 years ago; and whatever she might have read on consumer or medical web sites or medical journals.  Lastly, in some cases we would get informal consult or input from my medical pals.

Depending on how you want to count, that is 8 or 9 sources!!!  I can hear some of you readers saying, “go with what the doctor says, and downplay the others”.  Some might advise, “go with the handwritten, it is the most customized to your situation”.   Others will recommend, “consumer web sites have the gold nuggets from real patient experiences and tips.  Those doctors and nurses have never REALLY experienced XYZ disease, what do they know.”

Tools (computer or otherwise) need to help streamline or sort this out in a more understandable, easy to use way.  What do I mean by easy to use?  You need usability testing by patients and their caregivers — most realistically when they are sleep deprived, scared, in pain, etc.  Not a simple task to do this usability testing, but CRITICAL to success.