Content area
Full Text
This quality improvement project used an evidence-based self-care discharge bundle to decrease 30-day readmission rates in patients with heart failure. No statistically significant difference was found between groups (p=0.331), but a 50% decrease in readmissions occurred after this intervention.
Hospital readmissions are a significant contributor to increased healthcare costs. Readmission for heart failure (HF) costs $1.7 billion annually, or $13,679 per patient (Mirkin et al., 2017). In 2012, the Centers for Medicare & Medicaid Services (CMS, 2021a) initiated the Hospital Readmissions Reduction Program. The program decreased the reimbursement hospitals receive if patients have excessive unplanned readmissions for certain conditions, including HF. However, consistent patient education positively affects patient outcomes and decreases readmission (Sezgin et al., 2017). Use of teach-back, in particular, has been associated with a lower 30-day readmission rate for patients educated with this method (Oh et al., 2021).
Project Site and Reason for Change
The hospital in this project had an average 30-day HF readmission rate of 24.4% in 2019, which is above the national average of 21.4% (CMS, 2021b). The two units with the highest 30-day readmission rates (22%) were identified for the project. These units predominantly house older medical patients with multiple co-morbidities who have been placed on telemetry monitors.
This project took place over 9 months. Participants included adult patients over age 18 admitted with a primary diagnosis of HF, congestive HF, or HF exacerbation. Patients who were confused, did not speak English, were being discharged to a nursing home or personal care home, or refused to participate were excluded.
Program
A retrospective chart review was completed to obtain baseline data. Charts were reviewed over 3 months to determine 30-day HF readmission rates for HF signs and symptoms. The clinical nurse specialist (CNS) obtained a spreadsheet with all patient admissions to the selected units in August-October 2019. Admitting diagnoses were filtered for cardiac conditions; the CNS reviewed each patient to determine reason for patient admission, reason for discharge, and possible readmission. If the patient was readmitted, the record was reviewed to determine if the patient was readmitted with signs and symptoms of HF. Patients had to be admitted with HF and discharged home to be included in data collection.
The project used a pre- and postimplementation approach to determine...