Reduce Heart Failure Readmissions and Improve Patient Outcomes through Transitional Care
"Heart failure (HF) affects about five million people in the United States, with 550,000 new patients diagnosed each year” (Hines, Yu & Randall, 2010 ). "It 's the leading cause of hospitalization and healthcare costs in the United States and up to 25% of patients hospitalized with (HF) are readmitted within 30 days” (Feltner, et al, 2014). Heart failure is a chronic and progressive condition and patients usually have associated co-morbid conditions such as renal failure, chronic obstructive pulmonary disease and diabetes. All of these factors make patients more vulnerable to poor transition home or to other care settings such as skilled nursing facilities. Furthermore, the government and private insurance companies have begun penalizing hospitals for 30-day …show more content…
I am proposing five "transitional care interventions" if implemented collectively will decrease readmissions and improve patient outcomes. Comprehensive admission assessments should start on the day of admission and continue across care settings. The healthcare system needs to engage patients in their own care while enhancing teaching and learning for patients and their caregivers Medication reconciliation must be completed by a nurse, physician or pharmacist on admission and discharge to avoid medication discrepancies. Patient discharge instructions should be comprehensive, including a plan of care. Finally, post-acute care follow-up visits should be arranged prior to patient discharge and follow-calls or visits arranged 48 hours after discharge for high risk patients. "Up to 25% of early readmissions may be avoided with including discharge planning and collaboration among inpatient and outpatient health care providers and the patient or patient’s family" (Lee
"Heart failure (HF) affects about five million people in the United States, with 550,000 new patients diagnosed each year” (Hines, Yu & Randall, 2010 ). "It 's the leading cause of hospitalization and healthcare costs in the United States and up to 25% of patients hospitalized with (HF) are readmitted within 30 days” (Feltner, et al, 2014). Heart failure is a chronic and progressive condition and patients usually have associated co-morbid conditions such as renal failure, chronic obstructive pulmonary disease and diabetes. All of these factors make patients more vulnerable to poor transition home or to other care settings such as skilled nursing facilities. Furthermore, the government and private insurance companies have begun penalizing hospitals for 30-day …show more content…
I am proposing five "transitional care interventions" if implemented collectively will decrease readmissions and improve patient outcomes. Comprehensive admission assessments should start on the day of admission and continue across care settings. The healthcare system needs to engage patients in their own care while enhancing teaching and learning for patients and their caregivers Medication reconciliation must be completed by a nurse, physician or pharmacist on admission and discharge to avoid medication discrepancies. Patient discharge instructions should be comprehensive, including a plan of care. Finally, post-acute care follow-up visits should be arranged prior to patient discharge and follow-calls or visits arranged 48 hours after discharge for high risk patients. "Up to 25% of early readmissions may be avoided with including discharge planning and collaboration among inpatient and outpatient health care providers and the patient or patient’s family" (Lee