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30-day Readmission Review
30-day Readmission Review
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Created by Brandi Vela, RN, BSN at Delta Health
Case Management
Customer Created
Readmissions
Table of Contents
Audit Form
Audit Form
30-day Readmission Review
Required
Observed Date
Is the Index Admission Diagnosis a chronic condition?
No
Yes
Discharge disposition from index admission
Home - self care
Home with home health
SNF
Other
Number of days since prior admission
> 14 days
8 - 14 days
3 - 7 days
Have there been 4 or more hospitalizations at DCMH in last 12 months for this patient?
No
Yes
Was a patient interview completed?
No
Yes
Insurance
Select an Option
30-day Readmission Review Checklist
Mark all as...
Patient Interview
Unable to obtain or take prescribed medications
No
Yes
N/A
Patient or caregiver did not understand discharge instructions
No
Yes
N/A
Symptom relief for chronic condition
No
Yes
N/A
Unable to attend follow-up appointment
No
Yes
N/A
SNF sent patient to ED for physician assessment
No
Yes
N/A
Unable to access basic needs such as food, transportation, housing
No
Yes
N/A
Chart Review
Documentation that a medication list was provided to patient or caregiver at discharge
Yes
No
Information about the patient's condition was documented and provided to the next level of care receiver
Yes
No
N/A
For patients with a comorbid behavioral health condition, a follow-up appt with a behavioral health provider is documented
Yes
No
N/A
For patients that require assistance from social services, a direct linkage documented instead of asking patient to self-navigate
Yes
No
N/A
The primary learner/caregiver is identified and documented in the medical record
Yes
No
Teach-back is documented when discharge education is provided
Yes
No
N/A
Care transition plan included info about obtaining and taking medications
Yes
No
N/A
Care transition plan included info about s/sx and what to do if they occur
Yes
No
N/A
Care transition plan included a scheduled follow-up appointment and was documented in the discharge packet
Yes
No
N/A
Care transition plan included plan for transportation to get to the follow-up appointments
Yes
No
N/A
Care transition plan included follow-up labs or tests
Yes
No
N/A
A post-discharge phone call is documented
Yes
No
N/A
List other reasons contributing to readmission as stated by patient
Do not enter protected health information (PHI)
