Medicine and Health Sciences Commons^™

Early Aggressive Hydration Is Associated With Decreased Opioid Use And Readmission In Mild Acute Pancreatitis, Shreyans Doshi, Hong Liang, Hale Z. Toklu, Selina Fritze, Sue-Wei Luu

HCA Healthcare Journal of Medicine

Background: Acute pancreatitis (AP) is one of the most common causes of hospital admissions due to gastrointestinal disorders. No pharmacologic agents have been proven to impact the prognosis, and the treatment still remains supportive with intravenous fluids for hydration. Although early hydration has been recommended for the management of mild AP, there is no consensus on the type, rate, and amount of the fluid replacement.

Objective: In this study, we aimed to investigate the outcome of aggressive hydration in patients with AP.

Methods: Retrospective data from patients admitted to 12 hospitals (2015–2017) was used for analysis. Five hundred patients who …

Improving Care Experience Of Total Joint Home Recovery Patients Through Nursing Education, Earvin Ledi

Master's Projects and Capstones

Problem: At a Northern California hospital (NCH), there is a current effort to ensure the perioperative patients are satisfied with their care. These patients receive the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey after surgery. The scores regarding discharge process and patient knowledge over the last five quarters have fluctuated between the 10th percentile and the 36th percentile. NCH relies on patient satisfaction scores to better serve their members.

Context: NCH understands the higher the scores, the more members they will retain and the higher the overall income. Based on the low OAS …

Bridging The Gap: Improving Hospital Discharge Through Utilization Of A Priority Care Clinic, Kristian Jamerson

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Poorly coordinated care often results in poor health outcomes. Best practices in academic literature recommend effective programs that consist of comprehensive discharge planning, complete and timely communication of information, medication reconciliation, patient and caregiver education using the teach-back method, open communication among providers, and prompt follow-up visits with an outpatient provider after discharge. Using a priority care clinic (PCC) for follow-up is one approach to decrease hospital readmissions.

Purpose: To implement an evidence-based program utilizing a PCC to facilitate post-discharge transition-in-care and reduce hospital readmissions.

Evidence-based Intervention: A PCC assists patients in their transition of care from the …

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

Application Of Condition‐Based Maintenance In Health Care: A Concept Analysis, Lindsey J. Ryan Phd, Rn, Acns‐Bc, Ne‐Bc

School of Nursing and Health Science: Student Scholarship

Chronic illness burdens individuals, organizations and society, costing the US $3.5 trillion annually. Transposed from the engineering industry, condition‐based maintenance is a novel concept that holds great promise for alleviating this burden by enhancing current health care delivery methods. Aims of this concept analysis include, (a) develop an operational definition for the term condition‐based maintenance and (b) discuss the applicability and effectiveness of condition‐based maintenance as applied to health care. A search of engineering and health care literature was completed. The search term “condition‐based maintenance” was entered into the PubMed, Wiley Interscience Journals, CINAHL, Journals@Ovid, ProQuest Nursing & Allied Health …

Using The Engaging Parents In Education For Discharge (EPed) Ipad Application To Improve Parent Discharge Experience, Stacee M. Lerret, Norah L. Johnson, Michele Polfuss, Marianne E. Weiss, Karen Gralton, Carol Klingbeil, Cori A. Gibson, Mauricio Garnier-Villarreal, Sheikh Iqbal Ahamed, Riddhiman Adib, Rachel Unteutsch, Louis Pawela, Rosemary White-Traut, Kathleen J. Sawin

College of Nursing Faculty Research and Publications

Purpose

The purpose of this study was to evaluate the use of the Engaging Parents in Education for Discharge (ePED) iPad application on parent experiences of hospital discharge teaching and care coordination. Hypotheses were: parents exposed to discharge teaching using ePED will have 1) higher quality of discharge teaching and 2) better care coordination than parents exposed to usual discharge teaching. The secondary purpose examined group differences in the discharge teaching, care coordination, and 30-day readmissions for parents of children with and without a chronic condition.

Design/Methods

Using a quasi-experimental design, ePED was implemented on one …

Implementation Strategies To Reduce Hospital Readmission Rates In Adults With Sepsis: A Quality Improvement Project, Erin Kucharek

Doctoral Projects

Background: Sepsis is a concern in healthcare, as patients are 2 to 3 times more likely to be readmitted to the hospital than those with other illnesses. Readmitted patient with sepsis costs the healthcare system $3.5 billion dollars per year. Effective care coordination is a tool that decreases readmission rates in other illnesses and is likely applicable to those with sepsis. The purpose of this quality improvement project was to determine if primary care provider follow-up appointments, increased home care utilization, and patient education would reduce sepsis readmissions.

Methods: The Transitional Care Model guided project design and The Kotter Model …

Multidisciplinary Team Approach To Prevent Hf Readmissions In Rural Areas, Naydu Lucas, Rn, Msn, Mba

Doctor of Nursing Practice Projects

Background: Despite the national efforts to decrease 30-days hospital readmissions, readmission remains a challenge for healthcare organizations across the continuum of care. The aim of this quality improve project was to develop and implement a multidisciplinary team approach to provide education to patients hospitalized with congestive heart failure (CHF) to improve 30-day hospital readmissions.

Method: This project was conducted in a critical access hospital in Northeast Washington. Using a pre-post design, we evaluated the 30-day readmission before and after implementing the multidisciplinary education program for patients hospitalized with CHF. The education focused on disease management, discharge education, pharmacy consult and …

Multi-Morbidities Are Not A Driving Factor For An Increase Of Copd-Related 30-Day Readmission Risk, Shuo-Yu Lin, Hong Xue, Yangyang Deng, Askar Chukmaitov

Health Behavior and Policy Publications

Background and Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. COPD is expensive to treat, whereas the quality of care is difficult to evaluate due to the high prevalence of multi-morbidity among COPD patients. In the US, the Hospital Readmissions Reduction Program (HRRP) was initiated by the Centers for Medicare and Medicaid Services to penalize hospitals for excessive 30-day readmission rates for six diseases, including COPD. This study examines the difference in 30-day readmission risk between COPD patients with and without comorbidities.
Methods: In this retrospective cohort study, we used Cox …

Cardiac Risk Factors Predicting 30/90 Day Readmission Rates In Lumbar Decompression Surgeries, Blake Nourie, Kevin Xiao, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Characteristics And Outcomes Of Patients Discharged Directly Home From A Medical Intensive Care Unit, Preeyal M. Patel, Michele Fiorella, Ms, Ann Zheng, Erika J. Yoo, Md

Phase 1

Introduction: Discharging patients directly home from the ICU is becoming increasingly common, largely driven by decreased ward bed availability. We evaluated readmission patterns of ICU patients discharged directly home.

Methods: Retrospective review was conducted of direct discharges from the ICU to home between June 2017 and June 2019. The primary outcome of interest was 30-day hospital readmission. Patients were dichotomized by “wait-time” between transfer order and hospital discharge (<24 hours or ≥24 hours). Outcomes were compared using t-test, Fisher exact, and chi-squared. Risk-adjustment was performed using the Mortality Probability Model (MPM₀-III). ICU workload was estimated using the nine equivalents of nursing manpower use score (NEMS).

Results: 331 patients were identified, with a mean time of 0.72 [0 - 5.84] …

Cardiac Risk Factors Predicting 30/90-Day Readmission Rates In Lumbar Decompression Surgeries, Kevin Xiao, Blake Nourie, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Characteristics And Outcomes Of Patients Directly Discharged To Home From The Intensive Care Unit, Ann Zheng, Preeyal M. Patel, Michele Fiorella, Lauren Mcdonnell, Mina Yasuoka, Erika J. Yoo, Md

Phase 1

Introduction: Given the current era of decreasing hospital bed availability, there has been a rise in the practice of direct discharge to home (DDH) from ICUs. We evaluated the demographics, clinical characteristics, outcomes and readmission patterns among DDH patients.

Methods: Retrospective review of patients from 2 MICUs from June 2017 to June 2019 at Thomas Jefferson University hospital, an urban tertiary care center. Primary outcome of interest was 30-day hospital readmission. Patients were dichotomized into two groups based on time between ward transfer order and hospital discharge (<24 or ≥24 hours). Risk adjustment performed with Mortality Probability Model (MPM0 -III). ICU workload at admission and discharge was estimated with nine equivalents of nursing manpower use score (NEMS). Patient characteristics compared using t-test and Fisher exact or χ² test.

Results: 331 DDH patients were analyzed, with the majority …

The Impact Of Native Language Status On The Frequency Of Heart Failure Readmissions, Cooper Blazek, Dave Katzianer, Md

Phase 1

Introduction. Heart failure readmissions are costly and lead to poor health outcomes. The efficacy of discharge instructions or other outpatient interventions may be affected by patient’s primary language status. The aim of this study is to look at the impact of primary language status on the frequency of heart failure admissions.

Methods. This study was a retrospective chart review of EMRs, on Epic software, at Jefferson academic medical center and community affiliate in Philadelphia, PA between March 2017 and October 2018. Patients were included if they had a principal diagnosis of HF or a diagnosis associated with “acute” heart failure …

Socioeconomic And Health-Related Factors Affecting Congestive Heart Failure Readmissions, Jollibyrd Miguel Gusto

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) readmissions are frequent and costly, but preventable. These readmissions not only contribute to rising healthcare cost but also affect the quality of life of these individuals and their loved ones. Guided by the social ecology model for health for health promotion, the purpose of this study was to analyze the socioeconomic and health-related factors of CHF readmissions. The main hypothesis of this study was that there was a relationship between 30-day readmissions of individuals with CHF and their payer status, race, ethnicity, primary language spoken, living arrangement, and comorbidities in the dataset as identified in their …

Reducing Readmissions For Patients Hospitalized With Congestive Heart Failure, Morgan B. Morgan

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is the leading cause for readmission in hospitals and has a

high mortality and morbidity rate, with implications for hospitals and third-party payers.

Readmissions of patients with CHF are related to inadequate patient knowledge at

discharge, inadequate follow-up with a health care provider, and treatment regimen

nonadherence. Patients report feeling ill prepared to provide appropriate self-care during

the transition from inpatient hospital stay to the home setting. One strategy to assess the

patient's understanding following discharge education is through a process known as

teach-back. The purpose of this quality improvement initiative guided by Knowles's

theory was …

Telehealth Efforts To Reduce Hospital Readmissions Of Congestive Heart Failure Patients, Sirfornia L. Deasfernandes

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is a chronic condition that affects millions of individuals in the United States. There is no cure for CHF, but medical interventions can help treat the symptoms and improve health outcomes. The purpose of this quantitative study was to determine if telehealth services help to reduce the readmission status of patients diagnosed with CHF. The theoretical framework used in this study was the individual and family self-management theory to help focus on self-management behaviors that contribute to improving the patients' health outcomes. The research questions were focused on addressing CHF patients receiving telehealth services and whether …

Strategies To Reduce Costs Associated With Hospital Readmissions, Almunzer Zakaria

Walden Dissertations and Doctoral Studies

Hospital administrators struggle to reduce hospital readmissions to improve hospital performance. Reducing costs of readmissions is important to hospital administrators because it may lead to an inability to meet budget requirements. Grounded by complex adaptive systems and business process quality management principles, the purpose of this qualitative single case study was to explore strategies nonprofit hospital administrators use to reduce costs associated with hospital readmissions. Participants included 4 successful hospital administrators at 1 hospital in Doha, Qatar, who have responsibility for overseeing readmissions. Data were collected using semistructured face-to-face interviews and organizational documents. Traditional text analysis was used to identify …

Reducing Heart Failure Readmissions Through Staff Education, Christopher Davio

Walden Dissertations and Doctoral Studies

Heart failure is a chronic health condition that can have devastating effects on thephysical and social well-being of patients. One critical component to heart failure treatment is understanding of the disease process and daily self-management for patients. The gap in practice at an acute care facility in the northwest United States was the lack of comprehensive discharge patient teaching to patients diagnosed with heart failure. The project explored if a heart failure education session for nurses would increase knowledge and competency on heart failure education. Knowle’s theory of adult learning was used to frame the project components. Thirty-one nursing staff …

Racial Differences In Hospital Readmission And Reimbursement Rates For Patients With Congestive Heart Failure, Catherine Talongwa

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is associated with a significant economic burden that includes frequent emergency department visits, hospitalizations, and readmissions. The purpose of this study was to examine the differences, if any, between hospital readmission rates and insurance reimbursement rates for non-Hispanic Black and White CHF patients in California. The theoretical framework was Bandura's social cognitive theory. Secondary data for this quantitative study were obtained from the Office of Statewide Health Planning and Development and State Inpatient Databases from Healthcare Cost and Utilization for calendar year 2014-2016. A t-test and Levene's test for equality of variance were conducted on a …

Readmissions Of Heart Failure Patients: The Caregiver’S Perception, Jill Pansini

Walden Dissertations and Doctoral Studies

Heart failure patients account for 27% of readmissions within 30 days of discharge, which is an indicator of poor quality of care. Additionally, heart failure patients report that they do not receive adequate discharge planning, pointing to a need for improved discharge planning and practitioner follow-up. As the severity of heart failure increases, caregivers may be the key to decreasing readmissions. The purpose of this qualitative, hermeneutic phenomenological study was to explore the lived experiences and challenges faced by caregivers of heart failure patients ages 65 and over readmitted within 30 days of discharge. The transitional care model guided the …