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Decreasing Readmission of Heart Failure Patients-Solution

Heart failure (HF) contributes significantly to the disease burden, hospital readmission rates, and mortality. The disease affects over 6.2 million Americans yearly, costing the healthcare system over $30.7 billion, projected to rise to approximately $53 billion by 2030 if appropriate measures to reduce the disease burden are not adopted (Nair et al., 2020). Most patients diagnosed with HF die in the first year after being hospitalized, and the survival rate is 30-40% up to one year after initial hospitalization with HF (Nair et al., 2020). HF effects go beyond post-discharge, and many patients (23%) are readmitted within 30 days after discharge (Nair et al., 2020). Increased readmission rates have considerable consequences for the patient and the healthcare system, including increased stress among patients and increased healthcare spending in the healthcare system. Therefore, reducing hospital readmission rates, mainly preventable readmissions, is necessary. This paper aims to provide a literature review of the best available evidence regarding interventions to reduce heart failure patients’ hospital readmission rates.  (Heart failure Essay Example)

Literature Review

The high rate (23%) of 30-day heart failure readmission is a significant issue for patients and the healthcare system. According to Rizzuto et al. (2022), over one million individuals are diagnosed with HF annually, affecting over 6 million Americans. Multiple factors contribute to the high hospital readmissions of HF patients, including poor discharge plans, lack of planned continuity of care, insufficient patient education, medication nonadherence, and unclear patient expectations regarding their health post-discharge. Some of the interventions Rizzuto et al. (2022) review include educational intervention post-discharge, a checklist and symptom checker calendar that includes proper education, follow-up instructions, drug dosage, and use, and the teach-back method are linked to decreased readmission rates of HF patients. (Heart failure Essay Example)

Rizzuto et al. (2022) explore the effectiveness of self-care education in reducing 30-day heart failure readmission, implemented as a bundle, which Hinkle and Cheever (2021) describe as a set of at least three evidence-based approaches adopted to improve patient outcomes. The article investigates self-care strategies that help patients maintain their health and well-being and ensure an active lifestyle. The author aimed to reduce rehospitalization by 10% in a 442-bed academic teaching hospital which reported a 24.4% HF rehospitalization rate in 2019, more than the national average of 21.4%, adopting the Plan, Do, Act, Art (PDCA) for the implementation. The study involved 21 patients. The evidence-based self-care discharge bundle decreased the rehospitalization of HF patients by 50%, although the groups studied did not indicate a statistical difference. Conclusively, adopting self-care education is an effective way of reducing hospital readmission of HF patients. (Heart failure Essay Example)

Usinowicz et al. (2020) explore a multidisciplinary team-led intervention to decrease the 30-day readmission of HF patients. Usinowicz et al. (2020) acknowledge that most individuals 65 years and older are diagnosed with HF in the US, which could be a factor in the high mortality rate. Factors contributing to the high readmission rate include individuals above 65 years, high BMI, diabetes and chronic kidney disease comorbidities, reduced muscle strength, diminished gait, and depression. The strategy was implemented as an Outpatient Transitional Care Program (OPTCP), whose primary objective was continuity of care post-discharge, including guideline-based treatment, early intervention, ongoing education, 7-14 days follow-up visits, development of tailored plans, necessary treatment delivery, medication management guidance, self-care management strategies education for patient and family, and clinical patient assessment. Post-implementation data analysis indicated a 0.1% increase in patient satisfaction. From 2014 to 2018, all-cause readmission rates of HF patients within 30 days reduced from 6.25% to 2.71% in transition care. The rates also reduced from 22.30% in 2014 to 18.69% in 2018 in the Valley Hospital. Conclusively, the multidisciplinary intervention and the OPTCP reduced the 30-day all-cause readmission of HF patients. (Heart failure Essay Example)

Conclusion

The evidence reviewed demonstrates a clear purpose of adopting evidence-based interventions to decrease rehospitalization rates of HF patients. The articles acknowledge that heart failure contributes significantly to the disease burden, with considerable effects on patients and the healthcare system. The readmission rates of HF patients in hospitals are above the national average. Various factors contribute to the high readmission rates of HF patients, including age, comorbidities, lack of patient education, medication nonadherence, lack of continuity of care, old-age-related issues like reduced muscle strength and diminished gait, and poor discharge plans. Based on the evidence reviewed, self-care education and post-discharge outpatient care adopting a multidisciplinary approach effectively reduce hospital readmission of HF patients. The articles contribute to personal knowledge and improvement on ways to address the high rates of HF readmissions in hospitals. (Heart failure Essay Example)

References

Hinkle, J. L., & Cheever, K. H. (2021). Lippincott CoursePoint Enhanced for Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer Health. https://coursepoint.vitalsource.com/books/9781975186722

Nair, R., Lak, H., Hasan, S., Gunasekaran, D., Babar, A., & Gopalakrishna, K. V. (2020). Reducing All-cause 30-day Hospital Readmissions for Patients Presenting with Acute Heart Failure Exacerbations: A Quality Improvement Initiative. Cureus, 12(3), e7420. https://doi.org/10.7759/cureus.7420

Rizzuto, N., Charles, G., & Knobf, M.T. (2022). Decreasing Thirty-Day Readmission Rates in Patients with Heart Failure. Critical Care Nurse, 42 (4):13-19. https://doi.org/10.4037/ccn2022417

Usinowicz, E., Ronquillo, K., Matossian, B., Picewicz, B., Bartsch, E., Haddad, C., Abbate, K., & O’Connor, T. (2020). In Our Unit: Reducing Readmissions for Heart Failure. Critical Care Nurses, 40 (1): 82-86. https://doi.org/10.4037/ccn2020983