How patients can avoid returning to the hospital

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-host Dr. Tamika Perry and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Tamika Perry.

CARMENN MILES
Welcome, everybody. We're delighted to have you all with us today on Docs in a Pod presented by WellMed. I'm Carmenn Miles, alongside our co-host for today, Dr. Tamika Perry at WellMed at Redbird Square in Dallas, Texas. You can find this award winning show on any listening platform featuring podcasts, and you can also find us on the radio in several Texas markets. Each week we discuss health and wellness topics, especially those that impact the senior community. Our goal really is to share practical information on how we can all live healthier, happier lives and to help us better manage some of those pesky chronic conditions. So, we're super excited to have you listening in today. Thank you again for joining us. As mentioned, our co-host today is none other than the Dr. Tamika Perry. Dr. Perry is an associate medical director at WellMed at Redbird Square in the DFW market, and she oversees several large clinics in the Optum Care North Texas region. She's board certified in both family medicine and osteopathic treatment. Additionally, she earned a Master of Public Health from the University of North Texas Health Science Center, and she says she was inspired to enter a career in medicine to help provide quality health care to the disenfranchised. She enjoys working with families and communities as a whole and building relationships with her patients. She's traveled the world first as a child in a military family, and she continues to enjoy traveling today. I believe she's fresh off a trip as she joins us today. Where did you venture off to this time, Dr. Perry?

DR. TAMIKA PERRY
I spent a couple of weeks between Bali and Singapore. More time in Bali. Bali was beautiful. The people are beautiful, the food is fabulous, it's hot. Singapore was great, but I really liked Bali. Singapore is like a big, clean New York City. It is very nice. But, yeah, I love Bali. I definitely will repeat that trip in the future.

CARMENN MILES
That's fantastic. I'm a lucky host today because I have two of my favorite medical professionals with me for this show. We have a great topic today, and I know I won't get a word in because the knowledge that you, Dr. Perry, and our guest sharing today, we will be hanging on tight to every single word. What an honor to have you and our guest together at the same time for this show. Our guest today is the great Dr. Jyothi Rereddy from WellMed at Garland in the Dallas-Fort Worth market. Dr. Rereddy is a wealth of knowledge and I love that she doesn't skirt the issues. She's extremely passionate about her calling the medicine, and she does not skimp on sharing knowledge. Dr. Rereddy is a board certified internal medicine physician at WellMed at Garland in the Dallas Fort Worth area. Dr. Rereddy earned her medical degree from Osmania University in India and completed her residency at Strong Memorial Hospital in Rochester, New York. As I mentioned, Dr. Rereddy really digs in with her patients. She provides a safe space for patients to share and ask questions. We are absolutely delighted to have you back on the show with us today. Welcome back, Dr. Rereddy.

DR. JYOTHI REREDDY
Thank you, Carmenn and Dr. Perry, always my pleasure. I am very delighted to be taking this topic on today's show. This is a very important topic in our practice from day to day. Dr. Perry can vouch for that. We see approximately 1 in 5 of Medicare patients are readmitted within 30 days of discharge.

CARMENN MILES
Yeah. Dr. Perry just shared with us some highlights on her recent trip to Bali and as soon as I finish, I'm going to try to figure out how I can get there, too. Like you said, I know there's one place that absolutely no one in their right mind wants to visit or revisit, and that is the hospital, right?

DR. JYOTHI REREDDY
It's a scary place. A lot of times when people go to the hospital, they feel that they are fixed forever. Not so. When you come out of the hospital discharge, it's just the end of a treatment, but it is the beginning of recovery at home to be continued. So, a lot of times when people come out of the hospital, they do need close follow up to make sure that they do not have any complications or they're taking the medications correctly. So, it's very important.

CARMENN MILES
Let's take a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. Our podcasts are available wherever you listen to your favorite podcast. We're also available on the radio in several Texas markets. I'm Carmenn Miles, alongside co-host Dr. Tamika Perry, and our guest today is none other than Dr. Jyothi Rereddy, who is giving us the cheat sheet on how to avoid unnecessary return visits to the hospital after being discharged.

DR. JYOTHI REREDDY
Yes. Most of the hospital admissions come down to five things how patients end up back in the hospital. Number one is medication problems. Number two, missing your follow up care after coming out of the hospital with their PCP. Number three, not able to recognize warning signs when they're back at home. Number four is some kind of complications from the disease process such as infections. The last one, patients can also have challenges that they face at home. Sometimes we overlook those. So, that becomes an unsafe discharge and they're right back into the hospital. But the good news is that many of these are preventable. When patients understand their discharge plan, keep follow up appointments and take the medications correctly and seek help early when something doesn't seem right. That's the key for them to be able to get the right care at the right time to keep them at home and healthy.

DR. TAMIKA PERRY
Over and over again, the years that we've been doing this, Carmenn, you'll hear overall theme for me about this relationship with your primary care provider. This is where that relationship is paramount because we're going to bring it all together for you. When you get out of the hospital, you're going to see me or Dr. Rereddy and what's going to happen is we're going to go over all your medicines. What you had before you were in the hospital, what they prescribed to you during the hospital and what they gave you after your hospital stay. We're going to do something called a medication reconciliation. So, we reconcile that list. It may be shorter than the list you had before the hospital. It may be longer. Some of them may be temporary drugs, but this is important for us to go over that. Number one because like Dr. Rereddy said, medication mistakes or misunderstandings is one of the primary causes for rehospitalization. So, we want to make sure that we get that right.

DR. JYOTHI REREDDY
Absolutely.

DR. TAMIKA PERRY
We're also going to sum up who you need to go to. Do you need to see me and the cardiologist or just me? When I say me, I mean me, Dr. Rereddy, and any other PCP or anybody acting in a PCP function like in the APC. Who exactly do you need to see? Where do I need to spend my efforts at to make sure that I'm as good as possible? That is a bulk of our discharge discussion. What you were diagnosed with, your medications, your follow up care. Dr. Rereddy, isn't that how your conversation goes when you have it with the patients after they get out of the hospital?

DR. JYOTHI REREDDY
Absolutely. Number one caution is that if they understood the disease management plan. When they get home, what are you supposed to do? What are the new medications? What has been stopped? Sometimes the patients also need to know if they can resume their normal activities or need to be waiting until they get stronger and better. Follow up lab tests, appointments they need. To answer those questions is very crucial and understanding for the patient is also becomes very crucial. When we see patients going into the hospital, we maintain a continuous follow up with the patients even when they are in the hospital so that way we can guide them on how the discharge planning is going to be. So, we make sure their social concerns are answered or their caregivers are being set up, they have home health or physical therapy, or if they need oxygen, if they need an inhaler, nebulizer systems. So, we try to coordinate. We have health care coordinators in each clinic. We try to contact the patients through the hospitalization and follow up through their discharge process and after the discharge. Statistically, 50% of all the readmitted happened in the first 15 days. So, we try to see the patients within the first seven days and some very sick, high risk patients within three days just to wrap around care around them so that we did not slip through the cracks and end up back in the hospital get sicker during that very important time.

DR. TAMIKA PERRY
She makes a valid point. I mean, you could be admitted for CHF, and then your discharge doctor says you need to take your Lasix twice a day. Before the hospital, you took it once a day. You don't do your follow up appointment with your PCP and you're like, I love my PCP. She told me once a day, so IÕm going to do once a day. Here it is four days later, you're back in the hospital with CHF again, congestive heart failure, because you're really supposed to double up on your Lasix for a couple days. Well, that's where Dr. Rereddy and I are going to reiterate that. So, for this period of time, this is what you're doing to make your disease stay better and prevent you from going backwards.

DR. JYOTHI REREDDY
Exactly. That follow up appointment, we put a lot of importance on those appointments. In some of the studies it has shown even though it's not the sole reason to readmission, but it has shown that patients who follow up their primary care timely right after discharge have about 20% lower risk in going back into the hospital, which is also significant, along with medication errors taking the most credit for putting patients back in the hospital. Following up with patients, we do also correct those medication errors.

CARMENN MILES
Very good information. Let's take just a quick break, but please stay with us as we continue this great discussion on hospital readmissions and how to avoid them after discharge. You're listening to Docs in the Pod presented by WellMed. We'll be right back.

AD
For over 35 years, WellMed has redefined health care for older adults and people on Medicare. We're physician led and nationally recognized as an Age-Friendly Health System. Our doctors take time to listen and support your unique needs, working with Medicare and select Medicare Advantage plans to keep you healthy and independent. With 24/7 nurse support, telemedicine, in-home, and office visits, care is always within reach. WellMed. Compassionate care, proven results. Visit wellmedhealthcare.com to learn more.

CARMENN MILES
We're back on Docs in a Pod. I'm your host, Carmenn Miles, along with our resident co-host, Dr. Tamika Perry. Our guest today is one of my favorites, Dr. Jyothi Rereddy. Such a treat because there are both goats in their field. Today we are chatting about how to avoid return visits to the hospital once you have been discharged. Dr. Rereddy, patients sometimes hesitate or shy away from asking the important questions. I don't know if it's the scrubs or if the white coat is intimidating, but understanding your discharge plan is absolutely imperative to understanding how to care for yourself or caring for a loved one once they've been discharged. What are some of the questions patients should ask before being discharged from the hospital?

DR. JYOTHI REREDDY
They come out of the hospital with a lot of new information. It's just like a fire hose down their throat coming out. I think having clear instructions for medications, diet, physical activity, warning signs is very, very crucial. For my patients, I also use a method what I call is teach back communication. This technique confirms that the patient is understanding by asking questions to explain information back in their own words. So, after I give them the instructions, they're going to tell me what they're going to do with this medicine. Why they're taking this medication, how long they're going to take it, when to stop the medication and how to recognize the warning signs. Also, understanding their disease management plan. For example, if they come out with uncontrolled diabetes, they need to understand what the highs and lows are that they should be watching out on the sugars. With COPD, same thing with the oxygen levels and their activity. Shortness of breath. They have to watch out. For the medications I always advise them to do a pill organizer to keep track. That is also a pitfall. Having too many medications, they can fall into those. Also, other health monitoring like daily weights, taking their blood pressure and watching for any swelling if they're having fluid on them. Those are important. Of course, appointments to make sure for the specialist, they know where they're going, what day their appointment is and why they're going there. To understand that is also very important for their patients. Also, nutrition. Low salt diet and low carbs and sugar diet. For kidney patients, fluid restriction. Some of the chronic conditions require very stringent nutrition guidelines to follow. Then of course, activity. Doing safely permitted activity at home is also very crucial. So, patients need to ask, what can I do? Can I walk? Can I do the stairs? How much can I walk? Very important. Also, sharing the same instructions with the family and caregivers is also very crucial. I would also I emphasize the patients to know about the red flags. So, they need to ask, when should I contact you? When should I go to the emergency room?ÊThat is also very important. These are some of the instructions. I think the more the patient understands, the more they are going to be able to access primary care easily. The sooner a patient reports symptoms, the more options we have to treat the problem before it ends up in a hospitalization.

DR. TAMIKA PERRY
Dr. Rereddy summed it up beautifully. What the patient should ask the provider, and they should not be intimidated to ask a provider. Remember, you are paying the provider for a service. So, that includes you asking them questions and they answer you competently. During pre-discharge planning and even post-discharge when you're with the primary care provider, in a nutshell there are five Ds we want the patient to remember. The first D is diagnosis. You should have a clear understanding of your diagnosis and if you don't, ask your provider again. Think of your medical provider, that doctor, nurse practitioner or physician assistant, as your health teacher. They are supposed to make sure you understand what's going on with you. And if you don't understand, ask again. Ask for some written literature. Ask someone else to explain it to you, but you should know what is going on with you. I draw pictures a lot in my practice because I did well in medical school, but if it was all pictures I would have been number one. Pictures tell a great story, right? Just make sure that you understand what's going on with you and what could bring you back to the hospital. You want to know what drugs you are on, like Dr. Rereddy so eloquently put. You want to know who your doctors are. If you needed a specialist because of this hospitalization, who saw you in the hospital? Who's going to resume that specialty care if needed after your hospitalization? You want to know any directions. If I can do sit ups, how do I need to do my setups? If I'm not allowed to go outside for two weeks because I'm recovering from surgery, when can I go outside after that two weeks and what can I do? So, what are my exact directions, not only on my medicines before my life post hospitalization? And if I have restrictions, how long are we going to be there? The last D is diet. What can I eat? Can I go back to microwaving Snickers and have them for breakfast? Likely not. But these are things that you definitely want to know. You want to know your diagnosis, your drugs, your doctor, your directions, and your diet. In a nutshell, if you remember that acronym, we're going to we're going to get you what you need, Dr. Rereddy and I okay.

CARMENN MILES
Wait, what are the five Ds again? One more time because that's important.

DR. TAMIKA PERRY
Diagnosis, drugs, doctor, direction and diet.

CARMENN MILES
Love it. Dr. Rereddy touched on this a bit, but when you're at home and you're transitioning that care home, what are some general red flags that happen sometimes that we should not overlook? When should we contact our doctor or when should we readmit or revisit the hospital? What are some of the red flags?

DR. JYOTHI REREDDY
Some of the red flags may vary about their conditions or what they're admitted for or what their existing chronic conditions are, but commonly, people having high fevers, shortness of breath that is not relieved by their normal, daily medications. Then blood sugars going dangerously high, not able to bring it down. Then if there is a breakdown in the skin, which is getting rapidly swollen and the infection is spreading on their extremities or on their body then some people can end up with sepsis from that. Very commonly, some of our seniors also get frequent urinary tract infections with the altered mental status. They don't want to eat, don't want to drink. That is a very huge sign for dehydration and infection in seniors. Those are red flags that we advise patients to call a PCP right away and, in some instances, to the emergency room.

DR. TAMIKA PERRY
There are a couple caveats to what she's saying. One, you should have with your discharge planning with your PCP something called a contingency plan. So, if these symptoms were to come along, then you either need to contact me or go right back to the hospital. So, if you are in the hospital for congestive heart failure and then you feel great now and you were swollen before, you were short of breath, you had gained weight like, five or six pounds in the last two or three days, you all like telltale signs of CHF, right? So, if you were in for CHF and now you're out and your weight is down, you're breathing better, and itÕs day 24 out but then 48 out of the hospital, you notice youÕve picked back up weight. YouÕre starting to be short of breath again. These signs and symptoms will be in your contingency plan, and if you don't hear something that sounds familiar when you're with your PCP, ask them, what's my plan if these symptoms were to happen, the same thing that I went to the hospital for, what am I supposed to do? Because that's what we're trying to prevent, right? So, that is caveat number one. Caveat number two is, the hospital is a dirty place. That's where sick people are. There's lots of germs there. So, while you're there you could get sick. That's one of the reasons we don't want you to go back. We want you there to be only for the time that you need to be there. So, like Dr. Rereddy said, if you come out of the hospital and all of a sudden, you're febrile, you're short of breath, you're coughing. Well, prayerfully you didn't get pneumonia while you were in the hospital or a respiratory infection while you were in the hospital. Even if you have symptoms that are outside of what you went to the hospital for, you need to disclose that to your primary care provider as soon as possible. You know your body. If you're in dire distress, you need to go back to the hospital. These are things that your contingency plan will will specifically tell you, hey, if these symptoms come along based on what you went to the hospital for and these other generic symptoms based on everybody who goes to the hospital, you need to do a U-turn, like they say in Uno, reverse, reverse, reverse.

CARMENN MILES
I love it. How important do you think it is, especially for our senior demographic, to have a support system in place and what advice you give to your senior patients who may not necessarily have the support that we would want them to have it during home care.

DR. JYOTHI REREDDY
I think it is very important. As the seniors are aging, the most important thing that I have noticed is that they do get lonely and depressed not having social support. So, I do encourage patients to be more open, engage in activities with the senior centers, with the church, with their neighbors, friend group. Very few of these seniors have close family support. So, this is important for them to be open to have their social circle and contacts maintained.

CARMENN MILES
Very good. Dr. Rereddy, Dr. Perry, I got to give you your flowers now. You're both just extraordinary at what you do, and we're just so thankful that you could join us today. Believe it or not, we're out of time. I want to thank you for joining us for this episode of Docs in a Pod. Please come back again, Dr. Rereddy. Listeners, just remember hospital readmissions can often be prevented through discharge planning, medication management, good follow up care, and maintaining good, healthy habits. Strong care transition practices and timely follow up appointments can significantly reduce readmissions. Listen, don't be a stranger. Subscribe to this podcast so you never miss an episode. If today's show helped you, sharing is caring. Tell your friends and family where to find us on any podcast platform, and you can also catch us on the radio in several Texas markets. Until next time, stay well!

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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