implementation of an evidence-based discharge checklist … · recognize three recommendations ......
TRANSCRIPT
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Item type Presentation
Format Text-based Document
Title Implementation of an Evidence-Based Practice Checklist toReduce 30-Day Readmission for Patients With HeartFailure
Authors Giscombe, Susan; Baptiste, Diana Lyn; Holley, MelissaJones
Downloaded 29-May-2018 21:55:37
Link to item http://hdl.handle.net/10755/622209
Implementation of an Evidence-based Discharge Checklist to Reduce 30-day Readmissions for
Patients Diagnosed with Heart Failure
Susan R. Giscombe, DNP, APRN, FNP-c
Diana Baptiste, DNP, RN
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28th Sigma Theta Tau International Research CongressJuly 2017
Objectives
By the end of this session, the learner will be able to:
1. Recognize three recommendations from the American Heart Association/ American College of Cardiology guidelines for discharging patients hospitalized with heart failure.
2. Identify two strategies for decreasing readmissions for patients hospitalized with heart failure.
Conflict of Interest: The authors declare no conflict of interest. The authors received no financial support or commercial sponsorship for this study.
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Background
• Globally, 23 million people are living with Heart Failure (HF)
• 5 million Americans with HF
• Annual costs: $34 billion
• Leading cause of hospital readmission
• About half of people who develop heart failure die within 5 years of diagnosis
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Significance
193-bed Rural Community Hospital in Northeastern U.S
• Readmission rate between 22% – 30%
• Up to 50% HF readmissions preventable
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Search Strategy
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Literature Review
•Use of a discharge checklist based on AHA/ACC recommendations can reduce 30-day readmissions.
•Providing evidence-based care is key to improving outcomes for patients w/ HF
•Providers are often interested in science-based discussions about quality improvement and value the implementation of evidence-based interventions.
•Hospital leaders can efficiently engage providers to promote use of EBP guidelines in practice
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Purpose
To implement an evidence-based discharge checklist and evaluate 30-day
readmissions among patients hospitalized with heart failure
Aim 1• Reduce 30-day readmission for individuals
hospitalized with heart failure.
Aim 2• Determine provider utilization of the
discharge checklist
Aim 3
• Determine provider satisfaction with using the discharge checklist
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Aims
Methods
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Quality improvement project, quantitative
Patients admitted for HF during September-November 2015 and September – November 2016
165-bed, rural community hospital
Demographic data
Pre and post implementation readmission rates, Provider utilization and satisfaction responses
Descriptive statistics, Independent t-test, Chi-Square
Design
Sample
Setting
Exploratory
Measures
Analyses
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Methods
SPSS
Group 1 Control
2015
Provider responses
Group 2 Intervention
2016
Innovation
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Innovation
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Analyses
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Descriptive Statistics/Frequencies
Independent Sample t-test
Chi-Square- Fisher’s Exact Test
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Exploratory Data
Results: Aim #1
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Result: Aim #2
Results: Aim #3
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Discussion
• Readmissions among groups not statistically significant
• Slight decrease in admissions
• Providers responded positively to checklist
• Checklist can be used to reduce readmission
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Discussion
Limitations
• Results are not generalizable
• Single-site study
• Relatively small, non-randomized sample
• Provider use of checklist not mandatory
• Survey questions, reliability
• Self-reported data by providers
• More data needed
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• Provider engagement is necessary for practice change
• Sustainability- Institutional and system-wide implementation
• Multidisciplinary discharge checklist integrated in HF order set in EHR
• Further study necessary to further validate effects of HF checklist
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Conclusion
Leading the way in education, research and practice – locally and globally.
• Al-Khazaali, A., Arora, R., Helu, H. K. (2014). Effective strategies in reducingrehospitalizations in patients with heart failure 2014.American Journal of Therapeutics
• Amarasingham, R., Patel, P. C., Toto, K., Nelson, L. L., Swanson, T. S., Moore, B. J., . . . Halm, E. A. (2013). Allocating scarce resources in real-time to reduce heart failure readmissions: A prospective, controlled study. BMJ Quality & Safety, 22(12), 998-1005. doi:10.1136/bmjqs 2013-001901 [doi]
• Balaban, R. B., Galbraith, A. A., Burns, M. E., Vialle-Valentin, C. E., Larochelle, M. R., & Ross-Degnan, D. (2015). A patient navigator intervention to reduce hospital readmissions among high-risk safety-net patients: A randomized controlled trial. Journal of General Internal Medicine, 30(7), 907-915. doi:10.1007/s11606-015-3185-x [doi]doi:http://dx.doi.org.proxy1.library.jhu.edu/10.1016/j.ijcard.2011.02.034
• Barker, A., Barlis, P., Berlowitz, D., Page, K., Jackson, B., & Lim, W. K. (2012). Pharmacist directed home medication reviews in patients with chronic heart failure: A randomized clinical trial. International Journal of Cardiology, 159(2), 139-143. doi:http://dx.doi.org.proxy1.library.jhu.edu/10.1016/j.ijcard.2011.02.034
• Basoor, A., Doshi, N.C., Cotant, J. F., Saleh, T., Todorov, M., Choksi, N., & Halabi, A. R. 2013. Decreased rea
• dmissions and improved quality of care with the use of an inexpensive checklist in heart failure.Congestive Heart Failure, 19(4), 200-206
• .
• Blum, K., & Gottlieb, S. S. (2014). The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. Journal of Cardiac Failure, 20(7), 513-521. doi:10.1016/j.cardfail.2014.04.016 [doi]
• Casteel, B. 2012. Simple heart failure checklist reduces readmission rates, improves care, could save billions. American College of Cardiology’s CardioSourece. 19-20
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References
References
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• Fonarow, G. C. (2011). Improving quality of care and outcomes for heart failure. Circulation Journal, 75(8), 1783-1790.
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References
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• Kociol, R. D., Peterson, E. D., Hammill, B. G., Flynn, K. E., Heidenreich, P. A., Piña, I. L., ... & Hernandez, A. F. (2012). National survey of hospital strategies to reduce heart failure readmissions: findings from the Get With the Guidelines-Heart Failure registry. Circulation: Heart Failure, CIRCHEARTFAILURE-112.
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• Turrise, S. (2014). Illness representations, treatment beliefs, medication adherence and hospital readmission in elderly individuals with chronic heart failure (Doctoral dissertation, Rutgers University-Graduate School-Newark).
• Wu, J. R., Lee, K. S., Dekker, R. D., Welsh, J. D., Song, E. K., Abshire, D. A., ... & Moser, D. K. (2016). Rehospital Delay, Precipitants of Admission, and Length of Stay in Patients With Exacerbation of Heart Failure. American Journal of Critical Care, 26(1), 62-69.
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