...In 2012, hospital readmissions for congestive heart failure (CHF) cost Medicare an estimated seventeen billion dollars (Simpson, 2014). As a result, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmission Reduction Program (HHRP) which identified readmissions to the hospital within 30 days of discharge a value-based payment modifier (Centers for Medicare and Medicaid Services, 2017). CMS uses value-based payment modifiers to financially penalize facilities with rates above the national average, citing this fact as an indicator of poor quality of care. As a result, hospitals across the nation have made reducing their readmission rate a top priority. Eastwood, Quan, Howlett, and Kind-Shier (2017) as well...
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...this project aims on understanding the drivers for this high cost and possible ways to control them. One of the important drivers for this high healthcare cost that we identified and will discuss in this paper is unnecessary care. Although there are number of factors contributing to unnecessary care, this paper focuses on four key issues mainly sterilization, hospital acquired infections, medical errors and hospital readmissions. Sterilization: Background of the issue Hospitals are hygienic paradoxes. It is where patients are cured from diseases and acquire a new one. Hospital hygiene is difficult to achieve. According to the World Health Organization estimates, “more than 1.4 million people worldwide are affected by infections acquired in hospitals” (Cleanhospitals.net). Why are there so many unclean hospitals and what body of people holds them accountable for medical negligence? How do you eliminate hospital-acquired infections (HAIs) and improve hospital hygiene standards? Current status and challenges Currently, many hospitals clean, disinfect, and sterilize hospital equipment. While hospital staff and nurses may be able to be trained on the proper cleaning procedures, equipment sterilization is not a part of the nursing staff’s core competencies....
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...is introducing new initiatives to reduce rehospitalizations and ultimately improve patient outcomes. Hospitals are under tremendous pressure to reduce their avoidable rehospitalization rates. In October 2012, hospitals started being penalized for having higher readmission rates. Jenks estimates that readmissions within thirty days of discharge cost Medicare more than seventeen billion dollars annually (Jenks, Williams, and Coleman, 2009). There is no doubt that readmissions following a hospitalization are very costly. This issue is critical in nursing today because skyrocketing costs can affect salaries and poor outcomes can be blamed on poor care. The quest for better outcomes proves to be a collaborative effort between hospitals, physicians, case managers, therapists, social workers and caregivers. In May of 2008 St Luke’s Hospital in Cedar Rapids, Iowa implemented a transitions in care program. They understood that the hand off from hospital to home was not working effectively. They focused on being sure that the patient as well as the care givers understood the patients diagnosis, plan of care and plan for follow up care with their doctors. They used the “teach back” method, by having the patients teach the nurses it allowed them to verbalize what they know and engage them in their own learning. The focus was on their heart failure patients and their readmission rate started at twelve percent. After education and discharging to home care, who was able to reinforce...
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...Predicting the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164(3). 365-372. Retrieved from: http://www.medscape.com/viewarticle/771215_print This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many that looked at prediction ability. The LACE+ index is a model that looks at length of stay, acuity, the Charlson comorbidity score and age, to predict readmissions. They found that no one model was appropriate in predicting the 30-day readmission rates, although using a combination of the models was an improvement to that predictor. The authors are all physicians, PhDs, or have a Master’s degree- helping to establish credibility. The authors also make a statement as to the funding of the project and that they (the authors) were solely responsible for all data collection, design and submission approval writing for the project, also lending credibility to the study. The references used for this study were appropriate in age, of the 28; 13 were within the last five years. Statistical data was gathered by experts and calculations made through third party experts, lending validity to the study. This article does not use the...
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...Preventing Heart Failure Readmissions Henry D. Santos Purdue University Calumet I. Introduction High morbidity, mortality, and healthcare spending have been connected with heart failure management. As per Gheorghiade et al., every year, there are almost a million cases of hospitalization for heart failure, responsible for 6.5 million hospital days, and estimated expenditures of $37.2 billion here in the United States alone (2013). The incident of heart failure readmissions has increased over the last decades, distinctly related to the aging population and surpassed recovery after a myocardial infarction. Based on the Centers for Medicare and Medicaid Services (CMS) 2005 data, heart failure is the most frequent diagnosis among Medicare beneficiaries and the third highest reimbursement for hospitals (AHRQ, 2013). In 2009, CMS started the public reporting of readmission rates after being discharge for heart failure, and, the year after, the Patient Protection and Affordable Act inaugurated financial penalties for healthcare establishments with most rates of readmission within the 30 days after discharge. The elevated concern relating the want to decrease readmissions has been the biggest focused of national researchers and hospitals with the efforts of identifying and predicting which patients with heart failure are likely to be readmitted. Formulated designs and preventive strategies have been established, in order to avoid unnecessary readmissions. Heart failures risk...
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...increases communication across the interdisciplinary team, enables nurses to provide their patients with high-quality care and decreases health care cost. The purpose of this paper is to describe why readmissions from nursing homes (NHs) is a nurse practice problem, nurse practice changes to reduce hospitalizations in NHs, evidence found in the nursing literature that supports the change in nursing practice and how to evaluate the change in practice after implementation of interventions. The Problem Residents in NHs continue to experience potentially avoidable 30-day readmissions to hospitals. Rahman, Foster, Grabowski, Zinn, & Mor (2013) define 30-day readmissions as when the resident is readmitted to the hospital within 30 days of being discharged from the hospital to NHs and avoidable readmissions as conditions that can be managed safely and efficiently in NHs instead of the resident being transferred to the hospital (p. 1901) There are more than 1.6 million Americans living in NHs in the United States and 23.5% of these Americans experience readmission to the hospital within 30 days of discharges and cost more than $17.4 billion per year in unnecessary health care cost (Ouslander & Berenson, 2011, p. 1165). The residents that are at an increased risk of readmission to hospitals from NHs have a diagnosis of congestive heart failure (CHF), pneumonia, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), or total hip and knee replacements (Kripalani, Theobald...
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...Memo #1: Potential challenges on ACA Readmission Patient Safety Organization (PSO) was designated by the Affordable Care Act to assist Hospitals with relatively high readmission rates to reduce the number. Readmission is defined as an admission of a patient to the hospital within 30 days of the date of discharge. According to the Centers for Medicare & Medicaid Services (CMS), University Hospitals was on the list of high readmission rates, with an AMI of 21.8, HF of 26.6, and a total of 1328 of discharges. There are many resources available on reducing unnecessary hospital readmissions, for example, the ProjectRED, which “can reduce readmissions by integrating better communication among clinicians and patients and by instituting follow-ups after discharge” (CMS). However, one important approach was to improve the transition process in inpatient and outpatient care for UH. By setting up a detailed and enforceable action plan to improve continuity of care, UH should focus on the following aspects: the compliance of national safety goals and regulations, the quality of transition approaches, the follow-up of regular reexamine, etc. These are not only methods to avoid high readmission rates, but also techniques to improve patient satisfaction and to reduce unnecessary administrative costs. Furthermore, another plausible approach is to bring closer relationship between hospitals and patient families, since they are an important part of patient satisfaction. Pay-for-performance ...
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...patients have higher in hospital mortality rates as well as longer inpatient length of stays. The objective of this study is to measure the incidence and determine the predictors of re-admissions to the Adult Intensive Care Unit. Methods: Medline (1946-present) was searched using combinations of the following search terms ‘Intensive Care Units’ OR ’Critical Care’ AND ‘Patient re-admissions’. The searches were limited to abstracts in English language between 1990 and 2014. This search was then narrowed to ‘core clinical journals’ to increase the quality of the articles but this limitation cut the number of articles down to 2/3rd and even though these articles were saved under a separate folder, eventually all 91 articles were included in the final search. The term ‘Intensive Care Units’ were narrowed to include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes identified. Conclusions: For a patient, coming back to the ICU is always a cause of concern for physicians, patients as well as their families. After reviewing a significant number of studies, we can see how certain...
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...a higher level of academic preparation than in the past. Advanced critical thinking skills are a must. Nurses need to function independently, making clinical decisions, providing bedside care, case management, education to patient and family in regards to disease process, treatment, and how to adapt to a healthier lifestyle. As healthcare continues to evolve and become more complex, it is necessary to assure proper education has been achieved. Controversy among the nursing profession has existed for many years regarding what is the acceptable minimum education for nursing practice. The ADN program takes 2-3 years to complete. The ADN programs started due to a need for nurses during a nursing shortage brought on by WWII. The ADN program provided a shorter period of time to acquire the necessary minimal skill to obtain licensure, and practice safe entry level nursing without the emphasis on leadership, nursing theory and critical thinking. The focus of ADN programs has been to prepare the nurse with considerable clinical experience and technical nursing tools needed to provide patient care at the bedside (Cresia & Friberg, 2011). They do not have the education to perform research activities which becomes the basis for the nursing care of today, as evidence-based practice. The BSN program takes about 4 years to complete and is college or university based. Both levels subscribe to the same nursing philosophies and teachings but the BSN expands on those philosophies and teachings...
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...Prevention of Hospital Readmissions Related to Symptoms of Congestive Heart Failure NRS 441V Professional Capstone March 1, 2014 Abstract Providing patients diagnosed with Congestive Heart Failure effective teaching can eliminate reoccurring hospitalizations. Patients are discharged with CHF and readmitted within 30 days. The information provided will examine the process of enhancing patient knowledge and provide additional resources essential for effective health care management. Research evidence provides data that proves patients who are diagnosed with CHF needs a variety of health care needs during admission and after discharge. The proposal will display an evaluation plan, implementation plan and a dissemination of the evidence. Provide at least 1 evidence based literature; for at least 1 evidence based solution. Keywords: congestive heart failure, therapy, education, patient outcomes Description of the Problem Prevention of Hospital Readmissions Related to Symptoms of Congestive Heart Failure Health care providers must ensure skills, knowledge and teaching is effective when providing care to their patients and families about symptoms of CHF. The length of stay for an average hospital visit can be two days however, for more chronic issues warrant an even longer stay. To avoid readmission of the disease processes of CHF warrants additional care and resources during and after discharge. . Some patients cannot follow up with their primary care physician because...
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...The evidence based guidelines incorporate the new mandatory pre-op class with the daily work-flow of the unit. Nurses would continue the education process learned in pre-op class, reinforce pain management and promote infection prevention. By attending the mandatory class patients will be more aware of factors that can influence their recovery. Quality improvement data will show an improvement in patient satisfaction scores, decrease in infection rates and a decrease in readmission rates for total knee replacement candidates. Qualitative research will show improvement in the total knee replacement experience. The strengths of this research include clear and concise objectives, formal quality improvement and consistent results across multiple...
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...improving Quality and Value in the U.S. Health Care System August 2009 Preamble The Bipartisan Policy Center (BPC) is a public policy advocacy organization founded by former U.S. Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. Its mission is to develop and promote solutions that can attract the public support and political momentum to achieve real progress. The BPC acts as an incubator for policy efforts that engage top political figures, advocates, academics, and business leaders in the art of principled compromise. This report is part of a series commissioned by the BPC to advance the substantive work of the Leaders’ Project on the State of American Health Care. It is intended to explore policy trade-offs and analyze the major decisions involved in improving health care delivery, and discuss them in the broader context of health reform. It does not necessarily reflect the views or opinions of Senators Baker, Daschle, and Dole or the BPC’s Board of Directors. The Leaders’ Project was launched in March 2008. Co-Directed by Mark B. McClellan and Chris Jennings, its mission is (1) to create a bipartisan plan for health reform that can be used to transform the U.S. health care system, and (2) to demonstrate that health reform is an achievable political reality. Over the course of the project, Senators Baker, Daschle, and Dole hosted public policy forums across the country, and orchestrated a targeted outreach campaign to...
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...EHR/CPOE Implementation Executive Summary This thesis follows the implementation of Computerized Patient Order Entry/Electronic Health Record (CPOE/EHR) system implemented by Partners Healthcare System (PHS) during 2002-2003 for all its constituent practitioners. It looks at the problems faced during implementation of the system and identifies new potential problems that the system may encounter. Particularly in consideration is the effort it takes to convince healthcare professionals to switch to CPOE/EHR, the cost of installing the system, the potential of automating redundancies in the system and the potential of healthcare professionals getting skewed data out of the system suggestions. It looks at the management challenges faced by the administration when bringing about CPOE/EHR to PHS and divulges in some techniques that were used for tackling these issues. It defines ways in which the system is being used to improve patient healthcare and save millions of dollars for the government, healthcare facilities and patients alike. This thesis also finds ways to combat the potential problems that may arise later and the system and looks at related government policies and statutes which apply to the implementation. Finally some metrics of success are discussed their effectiveness in driving a result. Problem Definition CPOE/EHR Implementation can face a host of problems that can hinder the process flow and the acceptability of the system by the people involved. The initial...
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...Case Study 13 Analysis Elizabeth Sapp University of North Carolina at Charlotte The situational analysis of Emanuel Medical Center (EMC) reveals a not-for profit independent hospital located in Turlock, California that is encountering financial troubles as it struggles to remain open. Changes in federal regulations such as the implementation of the EMTALA (Emergency Medical Treatment and Active Labor Act) laws and lower reimbursement rates for federally run insurance programs, changes in service area demographics, and the evolution of the services that locally competing hospitals offer have all contributed to five consecutive negative operating margins for EMC. (Harris, Vogt, & Gilinsky, 2004). Strategic Options Strategic issues are those events that affect an organization and its position within its environment. In the case of EMC the President and CEO, Robert Moen will need to discuss the options available to the hospital with other leaders through strategic planning. This is a process of developing steps for an organization to accomplish its mission and vision through strategic strategies. To make this process a success analyzing and understanding the situation is done by performing an external and internal environmental analysis along with refining the organizations’ directional strategies. In the end, EMC has five possible strategic options including, merging the hospital, selling the hospital, closing the ED, closing the hospital, or doing nothing and trying to...
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...nursing also so called diploma programs verses the baccalaureate. The associate degree of nursing originally started off as a 4 month program to a few years. When the diploma program first started they were used as to meet the staffing needs of the hospital. (Brown, 1948; Goldmar and the committee for the study of nursing education in 1923). The cost of the programs sky rocketed in the money aspect of it, and money was being lost by the hospital that sponsored these programs. As a result of the diploma nursing programs being so costly, it cause other programs to join forces with other academic institutions and they formed AND, and BSN programs. They then became accredited by the regional and also they achieved their professional accreditation. Conceptual Foundations: The Bridge to Professional Nursing Practice, 5th Edition, pg. 25 The associate degree the students receive general education and clinical nursing courses. This program teaches nurses bedside care for other care settings such as hospitals, long term care facilities, private duty work, and home care. Some of the disadvantages of the associate degree of nursing programs do not go into detail on how to do research, management, budgeting, and statics. The course is taught so fast that you are not taught to do research, which can impede your critical thinking skills, you miss out on communication and leadership skills. Some of the advantages of the associate degree of nursing program is that it is more cost efficient...
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