Ascension Saint Thomas chaplains work with care team, hospital leaders to reduce readmissions

June 2024

SAN DIEGO – When an Ascension Saint Thomas chaplain wanted to help ensure that patients with congestive heart failure wouldn't need to be readmitted to the hospital, he got assistance from some of the about 500 churches in one four-county area that Ascension serves in Tennessee.

Rev. Brandon M. Cook speaks about how chaplains can work with clinical care teams and others to help reduce patient readmissions. Rev. Cook is a chaplain with Ascension Saint Thomas Hospital Midtown in Nashville.

In a session at the 2024 Catholic Health Assembly, Rev. Brandon M. Cook, a chaplain within Ascension Saint Thomas Hospital Midtown in Nashville, spoke along with Rev. Calin Tamiian, system director of spiritual care and clinical pastoral education with Ascencion Saint Thomas, about the efforts of the chaplain, Ben Wiles, and about why chaplains and hospital administrators should work together to reduce readmission rates.

They pointed out that chaplains and hospital administrators want patients to go home and live healthy lives, and they want hospital resources spent wisely so the facilities can continue to operate years from now.

Chaplain referral
Ascension Saint Thomas comprises 16 hospitals with over 250 sites of care across central Tennessee, including Nashville, Murfreesboro, and rural communities.

In the effort led by Wiles, Rev. Cook said a task force looked at heart failure readmissions, which were some of the highest readmission rates for hospitals within the Ascension Saint Thomas system. The task force made sure that every patient who came in with heart failure received a chaplain referral. The chaplains learned that many of the patients relied on church food banks where many of the foods were high in sugar and salt.

The hospitals worked with the churches to create heart-healthy food pantries, and they raised money to buy scales so the patients could monitor their weight at home. One church started a ride program to take patients to follow-up medical appointments. After the efforts began, the regional hospitals saw a year-over-year reduction in the patient readmission rate for congestive heart failure of 94%.

The chaplains' role in reducing readmissions was to "be a broker between the hospital and the faith communities to come to a mutual understanding of an action plan," said Rev. Cook. "Perhaps, most importantly, it was to ensure that each person, each patient felt as though they were being heard and cared for."

Costly issue
Readmissions cost hospitals money, Rev. Tamiian pointed out. According to one study, in 2018 there were 3.8 million 30-day all-cause adult hospital readmissions, with a 14% readmission rate and an average readmission cost of $15,200. In 2020, that cost increased to $19,500.

Unplanned readmissions within 30 days of discharge are part of a definition used by Medicare to determine financial penalties, the speakers said.

Rev. Cook wanted people to keep in mind the effect of readmissions not only on the hospitals' bottom line but also on patients' lives.

Rev. Calin Tamiian, Ascension Saint Thomas system director of spiritual care and clinical pastoral education, explains how unaddressed high readmission rates can hurt hospitals and their patients.

"They just know that their lives are being impacted by being in and out of the hospital," he said. "So our ultimate goal is not only to improve the Medicare definitions of readmissions so that we're improving our reimbursement, keeping our hospitals financially healthy, but it is also to reduce readmissions overall, because every patient matters and their stories are important."

Ministry imperative
Rev. Tamiian pointed out that reducing readmission rates is in line with the ministry's Catholic values: respect for human dignity, integrity, stewardship, and excellence, and that might mean different things to different hospital departments.

"They might take different forms," he said. "They might have different terminology, but ultimately, we all pay attention to the way in which repeated hospitalizations are manifested as a form of impoverishment."

Over the last year, Rev. Cook has worked with a research team on a project to correlate readmission rates with services provided by spiritual care and palliative care teams. The sample size is 331 patients. The research team is waiting for results from statisticians.

Since patients are most likely to first encounter the spiritual care department through a eucharistic minister or a priest, it's important that those pastoral care providers understand the dynamics of readmissions so they can hear patient concerns and inform the care team, said Rev. Cook.

For example, he saw a patient who had been readmitted several times for heart failure. The patient told him she was afraid to go home because there was nobody there to help her.

"Out of that discussion," he said," we were able to get her to a post-acute care setting where she felt like she had more support before going home."

New responsibilities
Chaplains sit on readmissions committees for each Ascension Saint Thomas hospital that meet every other month. They watch for trends and look closely at cases in which patients have died after several readmissions.

Chaplains are very comfortable in their spiritual care roles and being a pastoral presence for a patient, said Rev. Tamiian, but it's a challenge to be entrusted with a clinical role. He said Ascension Saint Thomas leaders have supported the chaplains in adjusting to their new responsibilities. The chaplains can work with the clinical care team to get a clear indication of what a patient prefers or talk with a patient about their fears before undergoing procedures, he said.

"I actually will go as far as to say that Jesus probably missed a great opportunity (during) the Sermon on the Mount to say blessed are those who have a chance to work with the chaplains," Rev. Tamiian said, drawing chuckles and applause from the audience. "Truly, the trust has been given to us."


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