Hospital readmissions remain one of the most persistent challenges in the U.S. healthcare system. Despite ongoing efforts, nearly 1 in 5 Medicare patients are readmitted within 30 days of discharge, costing the healthcare system over $26 billion annually (Centers for Medicare & Medicaid Services, 2024). A significant portion of these readmissions are considered preventable—often driven by gaps in follow-up, fragmented communication, and lack of timely visibility into patient status. 

This is where ADT Alerts (Admission, Discharge, and Transfer notifications) play a transformative role. When delivered in real time, ADT data enables care teams to intervene faster, coordinate better, and close care gaps before they escalate into avoidable hospital returns. 

What Are ADT Alerts and Why Do They Matter? 

ADT Alerts are notifications shared across care organizations whenever a patient is admitted, discharged, or transferred from a healthcare facility. These alerts originate from hospital systems and are typically shared through Health Information Exchanges (HIEs) or integrated care networks. 

Why they matter: 

ADT alerts provide real-time insight into patient movement, allowing care teams to: 

• Know immediately when a patient is hospitalized 

• Initiate post-discharge follow-ups earlier 

• Coordinate care transitions more effectively 

• Reduce the risk of a patient "falling through the cracks" 

Without ADT alerts, care teams often learn of hospitalizations days or weeks later—after the opportunity for timely intervention has passed. 

The Link Between Timely Intervention and Readmission Reduction 

Studies consistently show that the first 7–10 days after discharge represent the highest risk period for readmission, particularly for chronic and high-acuity patients. 

A meta-analysis of post-acute patients found that timely follow-up within 7 days reduced readmission likelihood by 20–30% (JAMA Internal Medicine, 2022). However, timely follow-up can only happen if providers know the patient has been discharged. 

Real-time ADT alerts bridge this gap. 

ADT Alerts Enable Critical Post-Discharge Actions: 

• Referral to care management or transitional care programs 

• Medication reconciliation and adherence review 

• Scheduling follow-up visits or telehealth check-ins 

• Assessing home environment safety and caregiver support 

These interventions directly reduce risk for chronic populations, including patients with: 

• Heart failure 

• Diabetes 

• COPD 

• Hypertension 

• Behavioral or mental health conditions 

Why It Matters More in Chronic + Post-Acute Care 

Patients with chronic conditions often experience care fragmentation—seeing multiple specialists, settings, pharmacists, and home health teams. 

Without real-time notifications, each provider operates with incomplete information. A study on chronic care coordination found that lack of shared visibility contributes to delayed follow-ups in 42% of preventable readmissions (Health Services Research Journal, 2023). 

ADT feeds provide the shared visibility needed to create connected, continuous care, rather than episodic, reactive care. 

How Clinicus Uses ADT Data to Reduce Readmission Risk 

While ADT data is powerful, it is often underutilized because many systems do not have the workflow intelligence to act on it. This is where Clinicus strengthens the impact. 

Clinicus transforms raw ADT alerts into automated, coordinated care workflows, such as: 

• Immediate care manager assignments after discharge 

• Triggering TCM (Transitional Care Management) workflows based on payer eligibility 

• Automated patient outreach via SMS/call reminders 

• Documentation prompts to ensure compliant follow-up timelines 

Real-World Impact 

Care organizations that implement real-time ADT alerts with care coordination workflows report: 

• 20%–25% reduction in avoidable 30-day readmissions (HealthTech Journal, 2024) 

• Faster post-discharge outreach (often within 24–48 hours) 

• Improved patient engagement and follow-through 

• Reduced care fragmentation among high-risk patients 

These outcomes directly support the shift to value-based care, where preventing readmission is both a clinical and financial priority. 

Conclusion 

Reducing readmissions isn’t simply about better discharge planning — it’s about ensuring continuous, real-time visibility into patient transitions. 

ADT alerts provide that visibility — and when paired with intelligent care management workflows, they translate information into timely action. 

As healthcare shifts toward coordinated, value-based delivery models, real-time ADT-powered care orchestration will become a non-negotiable standard for effective patient care. 

Because when care teams know exactly when a patient needs help — they can intervene early, prevent complications, and keep patients on a healthier path forward.