...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 factors have linear and non-linear relationships with readmissions to...
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...Reducing hospital readmissions is one of the top priorities of policy makers and medical communities. The Hospital Readmissions Reduction Program (HRRP) established by the Patient Protection and Affordable Care Act penalizes hospitals with higher than expected unplanned readmission rates among Medicare patients with acute myocardial infarction, congestive heart failure, and pneumonia.1 Centers for Medicare and Medicaid Services will expand applicable HRRP conditions to surgical conditions of total hip arthroplasty, total knee arthroplasty, and coronary artery bypass graft surgery.2 Many studies have examined the predictors of readmissions in various contexts,1 yet the following questions remain unanswered. First, little is known about readmission...
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...Annotated Bibliographies Lisa Stevens Kaplan University Annotated Bibliographies Au, A., McAlister, F., Bakal, J., Ezekowitz, J., Kaul, P., & vanWalraven, C. (2012). 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...
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...target or endpoint that enables the judgment if an operation, a drug or some form of therapy was successful. Hunter, Corcoran, Leeder and Phelps (2012) also give a definition for Outcomes in medicine, but these authors considered outcomes in the patients’ perspective, and it includes physical, mental, social and spiritual health, quality of life, life satisfaction, lifestyle, and the process of the health intervention. Other author (McAuliffe, 1998) also describes the definition of outcomes as the patient’s perceptions, and as results of the care received, considering symptom severity, functional capacity and quality of life. Some of those statements can also be applied to the nursing...
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...Reducing Rehospitalizations Elizabeth A Goebel Drexel University Reducing Rehospitalizations Change has become a major buzz word in nursing; everything is changing on a daily basis. If it isn’t the evolution in technology, changes in the reimbursement process, it 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...
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...The average readmission for heart failure was 24.3% based on my findings and the national average is 22.0%. Suggestions that may improve or decrease readmission rates are better discharge planning and reinforcing patient education. I have been forced to discharge patients that were not ready for discharge because the emergency room was filled with patients. Patient education is another thing that can be reinforced because many times the patient goes home with medications that they have no clue why they are taking it or they start to feel better and do not follow the recommended treatment...
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...18 Progress in Cardiovascular Nursing Winter 2008 www.lejacq.com ID: 6611 Heart failure (HF) is the leading cause of hospitalization for persons older than 65 years and often necessitates assistance from family caregivers.1,2 Approximately 40% of older adults are readmitted within 3 months postdischarge, resulting in significant health care costs.2,3 Indeed, more than one million hospitalizations attributed to HF cost the patient and United States health care system over $27 billion a year.1 Hospitalizations related to HF are complicated by the aging process, comorbidities, and psychosocial concerns that affect successful management.2 In a study of patient outcomes post– hospital discharge, Naylor and colleagues4 demonstrated that the use of advanced practice nurses (APNs) was effective in improving outcomes for patients with HF. The feasibility of adapting this approach is limited, however; costs for home visits by an APN are high, a shortage of APNs employed in home care exists, and funding for home care has decreased with the Medicare Prospective Payment System.5 An alternative strategy for promoting self-management of HF is the use of electronic home monitoring (EHM). EHM is a form of telemedicine in which medical/nursing management interventions are provided to individuals at a distance from the health care provider.6 The primary objective of this pilot study was to examine the effectiveness of postdischarge telemonitoring by an APN...
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...` ` Ofelia Aguado, MD, Cesar Morcillo, MD, PhD, Jordi Delas, MD, PhD, Mark Rennie, MD, Siraj Bechich, MD, ´ndez, MD, and Franscesc Rosell, MD, PhD Anna Schembari, PhD, Francesc Ferna OBJECTIVE: The objective of the study was to evaluate the effectiveness of a single home-based educational intervention for patients admitted with heart failure. METHODS: There were 106 patients: 42 in the intervention group and 64 in the control group. Patients were randomly assigned to receive an intervention by nursing staff 1 week after discharge. Primary end points were readmissions, emergency department visits, deaths, costs, and quality of life. RESULTS: During the 24-month follow-up, there were fewer mean emergency department visits in the intervention group than in the control group (.68 vs 2.00; P = .000), fewer unplanned readmissions S14 www.heartandlung.org NOVEMBER/DECEMBER 2010 HEART & LUNG Aguado et al Educational intervention in heart failure patients readmissions, emergency department visits, and deaths. The impact on healthcare costs and quality of life measures is also assessed. MATERIALS AND METHODS Design We previously5 described a randomized clinical trial performed at the Sagrat Cor University Hospital (a 400-bed urban teaching hospital). The trial included patients admitted to the internal medicine and cardiology services between July 2001 and October 2003 with systolic HF according to the Framingham criteria. All patients were in New York Heart...
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...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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...Running head: IMPROVING TEAM COLLABORATION April 9, 2015 Improving Team Collaboration As a home health care nurse multi-disciplinary collaboration regarding a specific patient can be very challenging. With the increasing number of complex patients, patients can have care provided from several different professionals with very different goals. These disciplines include: skilled nurse, physical therapy, occupational therapy, speech therapy, medical social worker, and home health aide. The lack of consistent communication between health care providers can lead to poor outcomes, such a falls, decreased patient satisfaction, and unplanned hospitalizations. For example if a patient has a medication change causing weakness or unsteady gate that is not communicated to the therapist, the therapist may send patient to hospital concluding it is a functional change instead of a medication side effect. This is just one of many things that can occur when poor communication occurs within a multi-disciplinary team. As previously mentioned home health care has seen a significant growth of increasingly complex patients requiring multiple disciplines in the home. Each member of the healthcare team has patient centered goals. It is necessary for each discipline to be aware of the goals that each discipline is working on to form a seamless plan of care. Due to the increased complexity of the plan of care it is necessary for the team to meet via conference call or in person to collaborate...
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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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...Discharge planning is a process that aims to improve the coordination of services after discharge from hospital by considering the patient’s needs in the community. It seeks to bridge the gap between hospital and the place to which the patient is discharged, reduce length of stay in hospital, and minimise unplanned readmission to hospital.1 Discharge planning is an established part of hospital care, but the process varies and is not entirely evidenced based. A Cochrane review analysed 11 randomised controlled trials looking at discharge planning in over 5000 patients and failed to show a reduction in mortality among elderly medical patients, lower readmission rates, or a shorter length of hospital stay.1 However, two trials in the review did report greater satisfaction of patients and carers when discharge planning was used.2 3 The Cochrane review concluded that discharge planning remains important as a small improvement, not detected by the studies performed so far, could still yield highly significant gains in health care with huge resource implications and better use of acute hospital beds.1 Unfortunately, none of the included trials assessed communication with primary care staff about patient transfer of care. This is an important aspect of discharge planning and another potentially important advantage for patients. On a patient’s initial contact with health services, discharge planning should be started.4 This is often difficult to achieve when acutely unwell patients...
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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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...The Effect of Telemonitoring in CHF patients Evidence Based Practice Project Sacred Heart University The Effect of Telemonitoring in CHF Patients Evidence Based Practice Project Question (PICOT) Question: In elderly individuals over the age of 65, does the use of a mobile phone-based medication adherence application, compared to a mobile phone texting reminder, increase medication compliance by 25%, within 12 weeks of implementing the program? Evidence Appraisal Matrix Source (APA) | Type of Study design (RCT, phenomenology, etc.)/Purpose | Level of Evidence(According toMelnyk & Fineout-Overholt) | Sample, settingInclusion/ExclusionCriteria | Methods, instruments, data analysis | Findings/Implications | Inglis, S. C. (2011). Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Of Systematic Reviews, (6), doi:10.1002/14651858.CD007228.pub2 | Systematic Review | Level I | Twenty-five studies and five published abstracts were included. 16 evaluated structured telephone support, 11 evaluated telemonitoring, and two tested both interventions. Inclusion criteria:only peer reviewed, published RCTs comparing structured telephone support or telemonitoring to usual care of CHF patients were included. | Various search engines such as: MEDLINE, EMBASE, CINAHL, and AMED were searched from 2006 to November 2008.Relevant studies and systematic reviews and abstract conference proceedings were hand searched. No...
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...The Economics of Health Care Quality and Medical Errors Charles Andel, Stephen L. Davidow, Mark Hollander, and David A. Moreno Charles Andel, MBA, BSRT, is Manager of Radiology Quality and Compliance at Loyola University Medical Center and a graduate of Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at cjandel@lumc.edu. Stephen L. Davidow, MBA, APR, is a health care marketing and communications professional with a strong focus on quality and patient safety. He is a graduate of Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at stephen@davidowcommunciations.com or 708-284-2300. Mark Hollander, MBA, is a financial manager at the Department of Veterans Affairs and graduate of Loyola University Chicago ’s Quinlan School of Business MBA in Healthcare Management program. David A. Moreno, MBA, is a biotechnology business analyst and graduate of the Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at dmoreno1@gmail.com. Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical...
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