...A survey was done on the leadership in hospitals views about the Hospital Readmission Reduction Program. The common viewpoint was the HHRP penalty was that it did not correctly account for the gap in socioeconomic status between hospitals. The HHRP is a way to lower readmission. The leadership us very worried about the size of penalties, the lack of adjustment, and the hospitals failure to influence patient obedience and post care. Some of the strategies of the HHRP are filling the disparities in communication. “A study from University of California San Francisco (UCSF) that focused on pinpointing the factors that contribute to the institution’s own hospital readmissions within 30 days of discharge found that 26.9% of readmissions were potentially...
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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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...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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...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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...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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...strategy starts with primary care providers and works through to the execution of the Patient Centered Medical Home (PCMH) concept. Building upon this foundation the strategy expands to specialists, hospitals, and ancillary providers of services to build a delivery system for Amerigroup . members that are aligned to produce better outcomes, higher quality, and lower costs. AmeriGroup Florida Amerigroup Florida, a health plan, works collaboratively with seven psychiatric hospitals to improve patients' transitions to outpatient care, with the goal of reducing readmissions. The plan's behavioral health manager meets quarterly with hospital leaders to review data on admissions and length of stay, discuss select cases of readmitted patients to determine how patient care could have been managed differently, and identify strategies to improve quality and reduce the risk of readmissions going forward. Strategies focus primarily on steps that can be taken in the inpatient setting to facilitate the provision of appropriate treatment and support services after discharge. The program significantly reduced overall readmission rates at participating hospitals. Patients involved in specific quality improvement initiatives that came out of the program also experienced significantly fewer readmissions, along with associated declines in inpatient days and costs. What They Did Many hospitalized psychiatric...
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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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...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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...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 on reducing subsequent hospital readmissions, emergency department (ED) visits, and costs and increasing the time between discharge and readmission among older adults with HF. Secondary objectives were to examine depressive symptomatology, quality of life, caregiver mastery, and social support for patients with HF. Background Older adults with HF face a high risk of early hospital...
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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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...Presentation of Evidence (Shadi, et al. 1051)conducted a cost-benefit analysis to determine the business case for beneficiaries of Medicare through post discharge care transition(PDCT) .The measurement for in this research included the PDCT cost benefit ratio and the abilities and skills of self-management that recipients posed .This study was based on a controlled randomized trial. The study was carried out on elderly recipients receiving treatment at a general hospital located in a rural area called upstate in New York. The research was carried out from October 2008 to December 2009. The recipients selected were provided with services as part of the PDCT intervention while the others were controlled through regular discharge from the hospital. The participants were selected randomly before discharge from the hospital. Inclusion and exclusion criteria were used during the study after the census of the patients’ daily medical care was obtained. Based on the medical number and record of individuals, they were randomly assigned to intervention and control groups. Three hundred and thirty three recipients were chosen for this study: 160 in the intervention group and 173 in the control group (Shadi, et al. 1051). Participants in this program were approached while they were hospitalized, and the program was explained to them before they signed the consent forms. The program consisted of three home visits by nurses who were tasked with the role of delivering the program. The intervention...
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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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...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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...Middle Range Theory Continues to Guide Nursing Practice Judy John Maryville University Middle Range Theory Continues to Guide Nursing Practice Nursing theory has three distinct categories to describe the level of abstraction: Grand, Middle-Range, and Situation-Specific (Meleis, 2012, p. 33). Hugh McKenna (1997) defined these three categories, stating: Grand theory is highly abstract and is broad in scope. Middle-range theory is more focused and is normally the end product of a research study. Narrow-range theory is even more specific and while also being based on research findings, it guides specific actions in the achievement of desirable goals (p. 17). When thinking about nursing theory, one might ask: What is the purpose of theory? Is it even relevant to current nursing practice? The best response to answer these questions I have found is from Meleis (2012): The primary uses of theory are to provide insights about nursing practice situations and to guide research. Through interaction with practice, theory is shaped and guidelines for practice evolve. Research validates, refutes, and/or modifies theory as well as generates new theory. Theory then guides practice (p. 35). This explanation of theory by Meleis identifies nursing as a profession. Without theory to shape and guide nursing practice and research, nursing would not evolve and would remain stagnant. Additionally, without theory could nurses really claim that we are a profession...
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