Tips to Reduce Hospital Readmission and Improve Recovery
Posted on 02/09/2024
Tips to Reduce Hospital Readmission and Improve Recovery

Discharge from a hospital stay is often a milestone in the recovery process. What takes place after exiting the hospital can dramatically impact both short- and long-term health goals. Returning home or to an alternate recovery location may present a unique set of circumstances that differ from our regular routines. Planning and preparation can prevent readmission to the hospital and help to create the best possible environment for healing.


1. Gather information to determine what level of care will likely be needed for the weeks ahead. If the hospitalization was scheduled in advance, create a list of questions for the medical team including the surgeon or treating physician to discuss before entering the hospital. Making plans and preparations ahead of time can build confidence and calm nerves to promote a positive outlook and create the setting for the best outcome.

2. Identify caregivers and draft a schedule allowing for backup in case of unexpected occurrences. Avoid making assumptions and involve the patient in planning who will be involved in their care. Openly discussing the patient’s needs, concerns, requests, and boundaries are important steps in creating an environment for the best mental and physical health. Keep in mind that not only the patient but also caregivers need support and breaks. Having our own needs met is essential in order to effectively care for others.

3. Plan who will set up the recovery environment and prepare for adequate space to safely navigate. If mobility devices will be needed, arrange to have them on hand before the time of discharge. As an alternative to purchasing, renting may be an option or devices may be available for loan from community support programs such as KC Help. (The Knights Community Hospital Equipment Lend Program) A hospital social worker may also be able to provide connection with resources. Temporarily moving furniture could help prepare the space and some equipment may need to be relocated daily. For instance, a patient who sleeps using a CPAP machine located at their bedside will also need access to the device if napping in a recliner located in a different room.

4. Be proactive in requesting involvement in discharge plans. The medical team should consult and include the patient and caregivers when preparing the discharge summary.

  • Ask questions and request a copy with detailed instructions.
  • Be sure to have a clear understanding of restrictions and recommended activity or exercises.
  • Remember to consider the projected timeline as the first few days home may call for different orders than a week or two in the future.
  • Write down the specific name of the diagnosis, injuries, surgeries performed, or other conditions.
  • Recording the name and dates of procedures or diagnoses will be helpful in the future in case of emergency and at future medical appointments.

5. Medications should be discussed as part of the discharge plan. Keep in mind preexisting routine medications, assuring that the medical team is aware of all prescribed and over-the-counter medications the patient may be taking.

  • Discuss potential interactions with the physician and pharmacist.
  • Discuss dosage and timing, including which medications should be taken regularly versus medication that may only be needed intermittently.
  • Write down the name and purpose of each medication in a log easily accessible to the patient and caregivers.
  • Include clear instructions such as frequency, taken with or without food, time of day, and how many hours between doses.
  • Be sure to record the time and amount of each dose taken.
  • Post the name, area of specialty, and phone number of physicians, pharmacy, and care providers in a visible and easily accessible location.
  • There may be an after-hours phone number or answering service through the physician’s office phone. Some pharmacies offer delivery service or mail service.
6. If there is a wound or incision, discuss care instructions with the medical team and request a copy of the instructions.
  • Ensure that the patient and caretakers all have a clear understanding of the wound care plan and that a supply of sanitary bandaging and other necessities have been acquired.
  • Ask about cleaning and showering instructions and be sure items needed to keep an area dry or protected have been procured.
  • Consider the use of a shower seat and securely installed grab bars to prevent injury and promote independence.
  • Ask the medical team how the wound or incision should appear as time goes on and how to be aware of signs of infection.
  • Remember to follow sanitation guidelines in cleaning and handwashing and have a supply of medical-grade gloves available.
  • Photos of the wound or incision may be helpful to track healing progress and to identify concerns.
  • Be sure to have ice packs or pillows for propping and comfortable positioning if needed.

7. Address any transportation needs determining who will transport to each upcoming appointment. Post a calendar with all appointments including time, facility name, address, phone number provider name, and purpose. It may be helpful to write down questions for each upcoming appointment or remember to bring the medication log with notes to each appointment. If needed, apply for and schedule Dial-A-Ride or People for People Transportation in advance. 


8. Remember that proper nutrition and hydration are crucial to good health and healing.

Open communication, purposeful planning, and making arrangements prior to discharge can ease the burden and free up time to help you and your loved ones focus on healing. Recovery is a process that may present challenges. Having a plan in place that can be adapted as needed provides a foundation to build upon. Companionship and connection are crucial in our daily lives, particularly during the recovery process. Those who are not located nearby or do not have availability in their schedule to be a caretaker can still offer support. A small gesture can make a large impact. Phone calls, texts, cards, or a visit from a friend, neighbor, or loved one can be an inspirational and meaningful part of the recovery journey.

Stay connected with our Healthy Aging Program for ongoing support and resources to enhance your well-being as you journey through the stages of life.