...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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...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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...in a whirlwind trying to contemplate my options relative to staffing. Several things are impacting my decisions. Any feedback you can provide would be appreciated. I will try to summarize the issues. Summary of Current Staffing and Budget for Medical-Surgical beds ------------------------------------------------- Currently, Christ Advocate has a total nursing hours per patient in medical-surgical of 8.93 for the 394 authorized beds. Since the hospital has chosen to not use LPN employees, the nursing staff is a mix of RNs and assistants. Since the budget is set for this year, in an attempt to increase efficiency and decrease readmits, I propose that staffing remain at 8.93 with an increase in RNs to at least 7.0 and decrease assistants to 1.93. With this mix, the budget will be increase by approximately $4K. These monies can be recouped in the decrease of Medicare penalty by having more RN hours per patient thereby decreasing Christ Advocate 30-day readmission rate of identified patients (Illinois Department of Public Health 2016). ------------------------------------------------- ------------------------------------------------- Impact of Medicare Reimbursement bonus/penalty on staffing Christ Advocate Medical Center currently experience the second highest readmission penalty in the state and we have increase our penalty each of the reported years, 96% in 2013 to 2.41% in 2016. To reduce our penalty we must increase staffing and decrease the number of hours per patient...
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...availability of health care practitioners who are well-trained in chronic care and have current information about the patient’s goals, preferences, and clinical status. It includes logistical arrangements, education of the patient and family, and coordination among the health professionals involved in the transition. Transitional care, which encompasses both the sending and the receiving aspects of the transfer, is essential for persons with complex care needs.1 Contents 1 Introduction 1 Historical Problems 2 Attempted Solutions 3 AmerisourceBergen Solution 3 Benefits 5 Outcomes 5 Summary Historical Problems with Transitional Care Despite considerable attention focused on improving 30-day readmission rates to hospitals, only modest change has been achieved according to the Centers for Medicare & Medicaid Services (CMS). Medicare Readmission Penalties Max Penalty 278 Hospitals 8.3% No Penalty fiscal year 2013 and rising to 3 percent in 2015—penalties that could reach into the millions of dollars for some hospi- tals. Patient outcomes from July 2008 to June 2011 dictated the penalties leveraged in 2013. Health experts say high re- admission rates for pneumonia, as well as other conditions, are mainly driven by lapses in post-discharge planning and...
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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...
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...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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...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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...diagnosed with CHF and teach them about heart failure management and how to prevent hospital readmissions. Congestive heart failure is an illness that effects millions each year and with proper management, individuals can still lead a productive life. Prior to the teaching presentation, a community teaching work plan proposal was developed which helped create an outline for the teaching lesson. This paper will review the teaching plan, the epidemiological rational related to CHF, evaluate the teaching experience, how the community responded, and what the strengths of the teaching plan were and areas that need improvement. Summary of teaching plan Teaching about congestive heart failure management and how to prevent returning to the hospital for complications related to CHF, is an important topic to discuss and educate the community about, especially the elderly. The teaching plan developed by this writer estimated the teaching time to last 30 minutes and would take place at Victory Home Care. Between the cost of paper and ink to make the pamphlet for educational handout and cookies, juice, and coffee for refreshments, the estimated cost was $30.00. The community this writer chose was a home health center, who assisted this writer in identifying and gathering a group of patients diagnosed with CHF, to come in and allow this writer to teach them about CHF management and hospital readmission....
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...slighted due to time constraints, and lack of staff, preparation and materials. The purpose of this paper is to discuss the importance of sufficient patient education prior to discharge for patients with residual home care. Research on this topic could have beneficial implications for patient satisfaction pertaining to quality education for home care prior to discharge. Evidenced-based research has illustrated that the development of educational tools to aid nursing in providing succinct and pertinent information of discharge criteria has attributed to a rise in patient satisfaction. Considerations for educational materials were preferred language, specificity of patient concerns, and simplicity of educational materials. Summary Contemporary day surgery: patients’ experience of discharge and recovery Gilmartin (2007) reports that surgical procedures once requiring hospitalization are now performed on an outpatient basis, which minimizes the opportunity for adequate discharge planning and instruction. Gilmartin (2007) suggests that due to the brevity of the patient’s stay, the importance of providing the patient with supportive information and instruction specific to the patient’s...
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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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...Change and Culture Case Study II Maria Ricks-Bailey HCS/514 August 22, 2011 Albert Hart Change and Culture Case Study II Madison Regional Medical Center (MRMC) and Richmond Community Hospital (RCH) merged and became Richmond Community Health System (RCHS). The new administration has initiated a significant reduction in force and tasked management to redesign patient care delivery; this includes the introduction of universal workers. A committee developed to assist in this process recommends transforming RCHS into a learning organization to encourage workers to adapt and excel despite the changes. After presenting past studies where this model failed when implemented in other organizations, administration charged management with making redesign and universal workers a success at RCHS. This task brings about many challenges: how does management begin the process of redesign? What work processes and performance expectations must be considered once the design is completed? What structures will management put into place to turn RCHS into a true learning organization? Additionally, what plans will be necessary to control the intra-organizational and inter-organizational communications that must occur to implement the job redesign changes? Finally, how can management ensure individual job satisfaction for the universal worker position? Implementation of Job Redesign The RCHS senior management team decided to redesign the job of nurses...
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...Health Human Resources Planning: an examination of relationships among nursing service utilization, an estimate of population health and overall health status outcomes in the province of Ontario November 2003 Gail Tomblin Murphy, PhD(c) Linda O’Brien-Pallas, PhD Chris Alksnis, PhD Stephen Birch, PhD George Kephart, PhD Mike Pennock Dorothy Pringle, PhD Irving Rootman, PhD Sping Wang, PhD Decision Maker Partners: Lucille Auffrey, RN Jean-Marie Berthelot Tom Closson Doris Grinspun, RN Mary Ellen Jeans, RN, PhD Kathleen MacMillan, RN, MA, MSc Barbara Oke, RN Judith Shamian, RN, PhD Barb Wahl, RN Funding Provided by: Canadian Health Services Research Foundation Nova Scotia Health Research Foundation University of Toronto Principal Investigators: Gail Tomblin Murphy Professor, School of Nursing Dalhousie University 5869 University Avenue Halifax, Nova Scotia B3H 4H7 Linda O’Brien-Pallas Professor and CHSRF/CIHR Chair, Nursing Human Resources Unit Co-Principal Investigator, Nursing Effectiveness, Utilization & Outcomes Research Unit Faculty of Nursing University of Toronto 50 St. George Street Toronto, Ontario M5S 3H4 Telephone: (416) 978-1967 Fax: (416) 946-7142 E-mail: l.obrien.pallas@utoronto.ca Telephone: (902) 494-2228 Fax: (902) 494-3487 E-mail: gail.tomblin.murphy@dal.ca This document is available on the Canadian Health Services Research Foundation Web site (www.chrsf.ca). For more information on the Canadian Health Services Research Foundation, contact the Foundation...
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...Executive Summary The United States continues to spend significantly more on health care than any country in the world; however, even though with this statistic the United States has a lot of uninsured and does not have the healthiest citizens. The lack of universal healthcare coverage in the United States has been a forefront issue. With the overwhelming amount of uninsured Americans and the past unsuccessful efforts of health care reform, the possibility of universal health care seemed to be very unlikely. The new healthcare reform bill that was recently passed under Obama’s administration anticipates covering 30 more million of the uninsured (Riegelman, 2010). However, this bill does not offer universal healthcare. While excellent medical care is available in the United States, the rising cost and the U.S. health care delivery system present many challenges for the consumer and lawmakers. This paper addresses four dimensions that are pivotal to the successes and failures of the system: cost, efficiency, quality. The cost of the U.S. health care system is higher than any country in the world. Its efficiency is also under heavy scrutiny. If it were not an emergency most physicians would require insurance verification. Therefore, patients would be delayed of treatment. Moreover, The healthcare system in the U.S. should be redesigned in terms of prevention rather than treatment when people are already sick. Insurance should not go higher for people that have pre-existing conditions...
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...Telenursing: The Way of the Future for Nursing Paula Heser, RN Chamberlain College of Nursing NR361: RN Info Systems in Healthcare Fall 2015 Telenursing: The Way of the Future for Nursing “The concept of Telehealth is not really new. When humans first began space exploration in the 1960s, astronauts’ health was monitored by transmitting physiologic parameters back to physicians on earth” (Stokowski, 2013). “Telehealth is the use of telecommunications technologies ad electronic information to exchange healthcare information and to provide and support service such as long distance clinical healthcare to clients” (Hebda &Czar, 2013). Telenursing is a new and exciting way of nursing that is innovative and shows the potential for growth in the ever-changing world of technology. Hebda & Czar defines Telenursing as the use of telecommunication and IT for the delivery of nursing services. An important role of the nurse is to completed the nursing process; assess, diagnosis, plan, implement and evaluate. In telenursing, a nurse conducts their patient centered care in the same way. As stated in Healthy People 2020, in addition, despite increased access to technology, other forms of communication are essential to ensuring that everyone, including non-Web users, is able to obtain, process, and understand health information to make good health decisions. Buy using telenursing, the nurse can assess and monitor the patient then advise and educate the patient and send...
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...safe handover : safe patients guidance on clinical handover for clinicians and managers diSclaimer This publication has been produced as a service to ama members. although every care has been taken to ensure its accuracy, this publication can in no way be regarded as a substitute for professional legal or financial advice and no responsibility is accepted for any errors or omissions. The ama does not warrant the accuracy or currency of any information in this publication. The australian medical association limited disclaims liability for all loss, damage, or injury, financial or otherwise, suffered by any persons acting upon or relying on this publication or the information contained in it, whether resulting from its negligence or from the negligence of employees, agents or advisers or from any cause whatsoever. cOPyriGhT This publication is the copyright of the australian medical association limited. Other than for bona fide study or research purposes, reproduction of the whole or part of it is not permitted under the copyright act 1968, without the written permission of the australian medical association limited. safe handover : safe patients guidance on clinical handover for clinicians and managers PREPARED BY THE AUSTRALIAN MEDICAL ASSOCIATION LIMITED ABN: 37 008 426 793 2006 Adapted from the British Medical Association’s resource ‘Safe Handover: Safe Patients.’ Dr Mukesh Haikerwal President, Australian Medical Association Dr Geoff Dobb Chair, AMA Coordinating...
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