Reducing hospital readmissions is on the minds of designers, operators, and owners across the healthcare design spectrum—and rightfully so as penalties for these continue to take effect.

During a session at the Healthcare Design Expo & Conference in Washington, D.C., this week, speaker Natalie Abell, a senior associate, applied solutions group, at the ECRI Institute, identified two emerging specialty outpatient concepts and how they could help address this issue.

The two concepts—post-discharge clinics and adolescent and young adult (AYA) cancer centers—were in ECRI Institute’s top 10 list of technologies for hospital leaders to be aware of and both present opportunities to intervene with a vulnerable population’s care routine and improve outcomes and results.

Starting with post-discharge clinics, Abell said patients leaving the hospital or healthcare facility are very vulnerable. “Eighty percent of discharge instructions are forgotten by the time they hit the parking lot,” she said.

The reasons for this not only include the fact that patients are recovering and still under the influence of medication, but also that many don’t have an established relationship with a primary care physician (PCP) with whom to schedule their follow-up, they have difficulties filling prescriptions, and that test results and medical records don’t always get transferred into their electronic health record (EHR).

To facilitate better post-discharge care and patient education, several operators, including Denver VA hospital, have implemented these after-care clinics where staff can check a patient’s health, assist with making follow-up appointments, review test results, and help regulate medications. Abell said while the concept is still too new to have much design evidence backing it, studies have started to show a correlation between timely follow-up visits and reduced readmissions.

Among the design considerations for a post-discharge clinic, Abell says these facilities typically consist of general exam and consultation rooms that provide consultation zones for patient education. Other design considerations for post-discharge clinics include:

  • Locate the facility on or near the existing hospital campus, typically within an ambulatory care center of medical office building
  • Create a one-stop service with access to a pharmacy and imaging near the clinic
  • Include space for other services, including social work and addiction and behavioral healthcare

“Avoiding the cost of readmission penalties makes them cost-worthy,” she said.

Turning her focus to cancer centers for those patients caught between pediatric and adult oncology services, Abell said around 70,000 young patients between the ages of 15 and 39 receive a cancer diagnosis every year in the U.S. In addition, survival rates are worse among this age group than infant and older adult cancer cases, and aren’t improving. Patients in this age group are also affected by different cancer types, including leukemia, lymphoma, and breast cancers.

Many cancer clinics aren't designed to t address the specific needs of this population, which desire ongoing education and fertility and family planning services, and are more emotionally and financially vulnerable than other patient populations.

AYA cancer centers should focus on specialized services, programs, and built environments for these young patients by providing separate spaces for infusions/clinical care and zones for rest and socializing. “Peer interaction is extremely important to them,” she said.

They also seek bright, colorful, homelike setting with lots of windows and that are outfitted with computers and gaming equipment. “They want to be distracted,” Abell said. “It’s an important part of their coping mechanism.”

Abell said many of these units originate in children’s hospitals and traditionally are supported by charitable organizations, such as Teen Cancer America. She estimates the cost for a hospital to run an AYA cancer clinic would be $3-5 million.

In addition to improving outcomes and access to educational resources, AYA cancer clinics can also promote more participation in clinical trials to help advance care. “Only 14 percent of [young cancer patients] enroll in trials compared to 60 percent in pediatrics,” she said.