Medicine and Health Sciences Commons^™

Reducing 30-Day Psychiatric Inpatient Hospital Readmission Of Mentally Ill Homeless Men With Substance Use Disorder By Using A Discharge Checklist, Chibuogwu E. Ogbuka

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Psychiatric inpatient readmission of mentally ill homeless men with substance use disorder is greater than that of the non-use population. Substance use disorder co-occurs with high prevalence among patients diagnosed with mental illness. For mentally ill homeless individuals discharged after inpatient treatment, substance use disorder negatively impacts health, behavior, and medication non-compliance, resulting in hospital readmission.

Problem: In acute psychiatric facilities in Northern California, the greatest readmission after inpatient hospitalization occurs at 53% in a week and 74.8% within two weeks of discharge. For homeless individuals, substance use disorder exacerbates personal problems and decreases the likelihood of …

Standardizing Congestive Heart Failure Education To Decrease Readmissions, Cyntia Boter

Master's Projects and Capstones

Background: The setting of this project took place in a small 100-bed community hospital that is a part of a larger healthcare organization in Northern California. The focus of the project was the implementation of standardized education for patients with congestive heart failure (CHF) to lead to an outcome of decreased readmissions. Readmissions to hospitals are costly and effective discharge planning can impact and decrease readmissions.

Problem: The facility in which this project took place has 35 readmissions a year for CHF. It is the third highest DRG and reason for readmissions in 2022. Although there is work in place …

Care Transition Assessment Redesign In The Acute Care Setting, Darla M. Johnston

Electronic Theses and Dissertations

There is a gap in case management professional practice with a lack of consistent, research-based transition evaluation (TE) tools available and used in practice. An evidence-based case management TE is necessary to develop a holistic and comprehensive discharge plan for hospitalized patients. Updating and implementing an evidence-based case management TE would positively impact the transition of care and promote improved health outcomes including a reduction in readmissions. This quality improvement project used a quantitative nonexperimental, interventional pretest-posttest design. Kirkpatrick’s multidimensional knowledge attitudes assessment (KAP) education evaluation model was used to assess (1) the influence an educational offering on evidence-based assessment …

Impact Of A Standardized Checklist On Post Discharge Appointment Attendance And Readmission Rates Of Veterans With A Mental Health Diagnosis, Henretta N. Milton-Williams

Doctor of Nursing Practice Scholarly Projects

Inpatient readmissions are among the most severe problems facing hospitals. Readmissions are most common in the first two to five days after discharge, especially among veterans with mental illnesses at the Columbia Veteran Administration Hospital System (CVAHS) inpatient units. The discharge planning process should begin as soon as a patient is admitted and should be updated throughout the inpatient stay to ensure a safe transition of care from inpatient to outpatient. This Doctor of Nursing Practice (DNP) quality improvement project is aimed to develop and implement a standardized checklist to streamline and organize the discharge planning for all veterans admitted …

Improving Medicine-Telemetry Discharge Process, Claire Cafirma

Student Scholarly Projects

Practice Problem: In Maryland, the most recent coronavirus disease (COVID-19) surge caused a significant increase in hospitalization and urgent demand for critical care beds. The identified delays in discharging patients from the emergency department to inpatient units resulted in more extended hospital stays, higher complication rates, and morbidity, which also impacted the health care organization's finances.

PICOT: The PICOT question that guided this project was in a medicine-telemetry unit (P), does the implementation of an enhanced electronic discharge planning tool (I) compared to the current discharge planning tool (C) affect timely discharge (O) during an eight-week time period …

Case Manager Discharge Planning For Safe Discharge Of Homeless Patients, Melody Jenkins

Master of Science in Nursing Theses and Projects

Acute care case managers are continually challenged with the task of identifying discharge barriers and preparing a discharge plan that facilitates successful recovery and healing. Planning a discharge for a patient that is homeless can be extremely challenging. This MSN Nursing project addresses the complex discharge barriers involved in planning a safe discharge for homeless patients. The project goal was to create a Case Management Resource Algorithm that will organize available community resources to meet the social determinants of health deficits to prevent the progression of disease processes, prevent repeat visits to the emergency room, decrease inpatient admissions, as well …

Improving Care Of Women Experiencing A Pregnancy, Belinda T. Ferguson

Doctor of Nursing Practice Projects

The purpose of the Doctor of Nursing Practice (DNP) project was to provide evidence-based staff education at a pregnancy resource center to increase staff/patient engagement and communication by implementing a clinical practice change and use of a DNP student-developed discharge summary referral form (DRF) to assist with assessing patient’s needs, evaluating access to services and utilization of medical care and health promotion services. The overall aim of this project is to increase care with medical follow-up and seek to address improving engagement and communication with patients during their care and after discharge from the Pregnancy Resource Center (PRC). The major …

Health Care Providers’ Use Of Nudging With Families Of Older Patients Making Discharge Decisions, Tabatha Bowers

Walden Dissertations and Doctoral Studies

The health care system has focused on reducing costs associated with longer lengths of

stay while facilitating safe and appropriate discharges. The purpose of this educational

project was to increase awareness among health care providers regarding nudging and

how it influences discharge planning decisions by patients and families. Enhancing health

care providers’ understanding of the impact of discharge communication may address the

issue of alternate level of care (ALC). Transition theory was used to frame the project.

Practice-focused questions addressed how the use of evidence-based case studies about

nudging could improve discharge planning for patients in a large community hospital …

Developing An Evidence-Based Discharge Process For Patients On A Cardiac/Renal Acuity-Adaptable Inpatient Unit, Tami Gallagher

Master's Projects

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase.

Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%.

Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness …

Interprofessional Collaboration To Improve Discharge Planning, Erica L. Spalding

Doctoral Projects

Historically, health care professionals collaborated solely with other professionals within the same discipline. However, evidence shows collaboration between all disciplines involved in patient care leads to improved patient outcomes. Interprofessional collaboration can reduce costs and improve patient care, yet is used inconsistently in health care systems. Interprofessional collaboration was not fully used on two medical-surgical units in a large health system in the Midwest, particularly during the discharge planning process. This project aimed to standardize rounds on two units as part of a larger initiative to standardize rounds across all units within the system. The clinical question to be answered …

Interprofessional Collaboration During Discharge Planning For A Large Midwestern Hospital, Sarah Shepler

Doctoral Projects

Introduction: Interprofessional collaboration (IPC) improves the quality of healthcare delivery. IPC enhances communication during discharge planning, through use of structured daily rounds to reduce readmissions, length of stay (LOS), cost, and mortality. A $240 billion reduction in cost could be achieved with IPC. The Joint Commission, Institute of Medicine, and World Health Organization emphasize use of IPC to reduce errors, improve patient outcomes, and refine transitions of care for patients.

Objectives: The goal of this project was to determine how IPC within structured daily rounds during discharge planning impacts patient LOS and staff satisfaction.

Methods: This quality improvement project was …

Evaluating The Discharge Process Improvement Initiative In Reducing The Length Of Stay, Maria Reina Ventura Siazon

Walden Dissertations and Doctoral Studies

Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation …

Reducing Inpatient Readmissions Through Early Follow-Up Appointment Planning: A Quality Improvement Project, Isabella Cuenco

Master's Projects and Capstones

Problem: Inpatient readmissions have a highly negative impact on healthcare systems. Not only do these hospitalizations have a detrimental effect on patient outcomes they also are accompanied by a prohibitive financial burden to the hospitals.

Context: Follow-up appointment with a primary care provider after discharge has been demonstrated as a viable strategy to reduce the risk of readmissions.

Interventions: Create a volunteer program to schedule patient appointments with a primary care provider within seven days of discharge.

Measures and Results: Compare the number of patients that were discharged with a follow-up appointment after the intervention to before the intervention, and …

Improving A Discharge Process To Decrease Readmission Rates, Erni Ensing

Master's Projects

No abstract provided.

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Discharge Risk Screening And Interdisciplinary Communication: A Method To Mitigate Discharge Delays, Tammy Linton

Nursing Theses and Capstone Projects

Identification of discharge barriers early during the hospital stay is essential to coordinate services post-discharge. Timely discharge of patients when medically safe controls costs, promotes positive health outcomes, and increases quality of care. Discharge planning is a multifaceted interaction that relies heavily on effective communication between all disciplines and the patient. Research suggests interdisciplinary collaboration and effective communication as leading strategies to mitigate discharge delays. The purpose of this study was to examine the impact of interdisciplinary collaboration on discharge planning and length of stay for medical surgical patients. A daily discharge team meeting was implemented as a best practice …

Patient Engagement In Transitional Care, Sheeree Dela Pena

Master's Projects and Capstones

The Clinical Nurse Leader Master’s project was conducted about a public health program called the Transitional Care Program that was working in partnership with a county hospital system, Santa Clara Valley Medical Center. The specific aim was to reduce hospital re-admissions of high-risk patients by supporting patient motivation and engagement in the Transitional Care Program by May 2015. Over a four-month period, data was collected through ten client visits, interviews with two public health nurses, information available about the program, and current research conducted on transitional care, hospital discharges, and patient engagement. Various aspects of the program were assessed, such …

Implementation Of Educational Program For Nurses To Improve Knowledge And Use Of Discharge Planning Best Practices, Eric C. Snyder

Doctor of Nursing Practice Scholarly Projects

Abstract

Problem Statement: The frequency and severity of hospital post-discharge events has become a national problem. The increase in readmission rates post-discharge has a negative impact on the patients overall morbidity and increases healthcare costs (Jack, 2012). Non-comprehensive discharge planning contributes to post-discharge events such as less than 30-day readmissions (Jack, 2012). Best practices for discharge planning should be utilized.

Purpose: The purpose of this project was to evaluate the impact of Project Re-engineering Discharge (RED) education to increase nurses' knowledge and use of best practices on discharge planning. An adapted Project RED educational intervention, using Knowles' adult learning …

Improving Patient Outcomes Through Use Of The Teach-Back Method In The Post Anesthesia Care Unit, Kathleen Osullivan

Master's Projects and Capstones

The setting for this Clinical Nurse Leader (CNL) project was the Post Anesthesia Care Unit (PACU) at a level I trauma center in the Bay Area. The goal was to improve the discharge education performed by the PACU nurses to improve patient safety and decrease the chance of complications or readmissions to this hospital. With no clear instructions for how discharge teaching should be done, the nurses have many differing styles which leaves room for gaps in discharge planning. This influenced the implementation of the teach-back method during discharge planning in order to ensure proper education and increased patient understanding. …

Re-Engineered Discharge Planning In A Rural Mississippi Hospital To Reduce 30 Day Readmission Rates Among Heart Failure Patients, Roxie Mae Hogan

Doctoral Projects

The hospital discharge is a complex process that involves interdisciplinary efforts to avoid readmissions and decrease health care costs. The purpose of this capstone project was to take a leadership role in translating evidence into practice by successfully preparing NWMRMC discharge planning stakeholders to adapt Project RED for use with HF patients admitted to NWMRMC.

A comprehensive systematic improvement plan, Project RED is designed to improve the work flow process through the use of timelines and strategies. Project RED supports discharge planning, helps to prevent readmission, and facilitates knowledge transfer that promotes sustainable changes. Re-Engineered Discharge Planning (RED), 6 step …

Inpatient Glycemic Management: Glucose Control Relationship With Hospital Variables, Discharge Planning And Education, Crisamar Javellana-Anunciado Phd, Fnp-Bc, Rn

Dissertations

This dissertation study examined the relationship of glucose control with clinical outcomes, costs, discharge planning and education. Extant studies showed that hyperglycemia, in the presence or absence of a diabetes diagnosis, is prevalent in hospitalized patients. Hyperglycemia is found in one-third of all hospital admissions and is linked to poor clinical outcomes and increased healthcare costs. Furthermore, clinical evidence suggests that lack of discharge coordination associated with medical errors and readmission. This entire body of work contains three distinct sections: Two manuscripts and a grant proposal. The two manuscripts in this study were based on more current retrospective data at …