CHF Hospital Readmission Rates

TASK 1 In the population of patients suffering from congestive heart failure, hospital readmissions within 30 days of discharge are common. The readmission rate causes negative effects on the patient's health, their perception of life quality, the healthcare system, and their trust in healthcare providers. High readmission rates also negatively affect healthcare facilities. Hospital readmissions have been proven to lead to greater opportunities for HAI’s, Medicare reimbursement, and the high cost of treating the disease. When educating a patient about their disease, the process used is usually verbal and or written methods; however, this education is not organized or standardized, allowing a gap to exist surrounding consistent treatment of this disease process. I have identified the PICO components to be as follows. P- Patients diagnosed with the chronic disease of congestive heart failure I- Standardized educational tool implemented during diagnosis and or hospitalization. C- Compared to current non-structured delivery methods of education O- Decrease in hospital readmissions between 1-30 days The EBP question I have developed: In patients diagnosed with CHF, would a standardized patient education tool implemented at diagnosis and or hospitalization, compared with current education methods, reduce the occurrence of day 1-30 hospital readmissions? Research article A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. The purpose of this article was to measure the efÏcacy of nurse-led, patient self management skills education, would be in the reduction of hospital readmissions for CHF patients. They cited the gap in knowledge on this topic and implemented a randomized controlled study to evaluate the outcome. In order to evaluate the effectiveness of nurse led patient self management, they established a structured educational plan. The educational plan included medication adherence, dietary modifications, social support, and symptom control. By patient self management, they identified the individual patient as the responsible party in implementing the being taught to manage their disease. Ninety-six patients, who all met a specific set of criteria, were divided into intervention and control groups by random selection. The control group received in hospital education per hospital practice that included education on diet, monitoring blood pressure, body weight, and urinary output. They also received written material to accompany them at discharge. The structured educational intervention was given to the intervention group throughout their hospital stay and at discharge. In addition to the hospital standard of education, the intervention group received a structured education presented by nursing staff who completed nationally accredited training in heart failure. The patients received a 1-hour education session by the nursing staff during admission, and an additional 1 hour of education before discharge. Both groups received 2 monthly clinic visits. The intervention group also received 4 weekly in-home phone interviews. After 12 months, the patients were reassessed in 2 areas. The primary focus was hospital readmissions due to shortness of breath, chest pain, arrhythmias, or syncope secondary to CHF. The second focus area was self-management ability measured by medication management, diet control, social adaptation and symptom management. Although the second area of measurement is more qualitative, the original question was quantitative. This was a randomized control trial, and per JHNEBP standards, this research article was appraised to contain evidence that proved it to be a level I article. The researcher analyzed the data by tracking the number of patients from each group that had been subject to hospital readmissions within the 12-month time frame. The patients from the intervention group had a 5% readmission rate within 12 months while the control group had a 10% readmission rate. Therefore, the results of this study answer my EBP question as evidence to support the use of standardized educational tools in patients hospitalized with CHF to reduce hospital readmissions between day 1-30 of discharge. Ethical consideration was taken by the researchers in this study and received approval from the hospital's ethics committee. The article also states that written consent was also obtained from all participants in the study. According to the JHNEBP model, this article was of high quality. The sample size was sufÏcient and consistent, and the conclusions were definitive. The literature review had through reference to scientific evidence, and the recommendations were consistent with this. Non-Research article Improving Inpatient Education and Follow-Up in Patients with Heart Failure: A Hospital-Based Quality Improvement Project. The purpose of this article was to review existing data to observe if there were direct connections in 60-minute standardized nurse-led patient self-management inpatient education and follow up phone calls, given by nurses who certified in CHF education, could reduce patient readmissions between 1 and 30 days, compared with the current methods of inpatient and discharge education. This article was done as a quality improvement project completed as part of a doctors of nursing practice requirement. The data was compiled from a high volume Heart and Vascular unit in a 292 bed hospital. The hospital piloted a standardized nurse-led patient self-management education program. The program included nurses certified in CHF education administering 60 minute in patient education followed by outpatient phone calls. The patients were also given written pamphlets that provided places for the patients to log weight and symptoms daily and listed red flag signs alerting patients when to seek medical intervention. According to the JHNEBP model, this article would be rated as a level V article. It is a nonresearch article that is part of a quality improvement initiative; therefore, per definition, falls into this category. This QI review was based on patient information from a single setÝng despite the clarity of objectives and scientific evidence resulting in a good overall quality rating. The authors recommendations support the validity and positive outcomes sought in the originally proposed EBP question. The article found that 60 min of standardized nurse-led patient selfmanagement inpatient education reduced the 1-30 day post-discharge hospital readmissions by 25%. The author also stated how their single setÝng review correlated with other studies on a certified nurse-led inpatient education. Practices changes to be implemented to address the EBP question were both proven and confirmed in the research and non-research articles reviewed. By implementing a structured nurse-led patient self-managed educational plan, followed by weekly phone calls after discharge, will reduce the readmission rate of patients diagnosed and hospitalized with CHF. The three key stakeholders in this venture are the Interdisciplinary team, Managers and Direct supervisors, and Administrators. The interdisciplinary team's role would be to consult on forming the educational plan and, given each specialty, add important elements to be addressed from their standpoint. The Managers and Direct supervisors would be the Responsible parties in ensuring the nursing staff becomes certified by an accredited agency on CHF. They also would be responsible for ensuring the unit complies with all aspects of the educational plan. Hospital Administrators would be needed to participate to receive their approval in moving forward with this initiative. One specific barrier to implementing the change in practice would be ensuring the follow-up phone calls were being made according to the structured educational plan. The addition of a telehealth RN to the unit would ensure compliance to the initiative's standardized structured nature to solve this challenge successfully. When all aspects of the proposal are implemented with consistency, tthe change in practice should achieve the expected outcome of reduced hospital readmissions between day 1-30 subsequent to discharge