Practice Issue
The topic
The topic of this practice issue is discharge planning from hospital for patients with congestive heart failure. The purpose of discharge planning is reduction of hospital stay as well as avoid readmissions (Gonçalves-Bradley, Lannin, Clemson, Cameron, & Shepperd, 2016). One of the opportunities to address this problem is his use of remote patient monitoring after discharge (Ong et al., 2016).
The nursing practice issue related to the topic
The practice issue can be identified with the use of ACE Star Model. The discovery stage reveals the existing nursing practice issue related to the problem of discharge planning for patients with CHF. Evidence summary disclosed an intervention to address the problem, which is the development of personalized discharge plans. Another stage comprises translation of evidence into practice and development of recommendations.
For this practice issue, it will include the development of an individualized discharge plan. The fourth stage of the model is integration to practice. At this stage, the developed plan will be implemented among CHF patients before their discharge. Finally, the impact of a personalized discharge plan on patient outcomes and readmission rates has to be assessed to evaluate the effectiveness of the suggested intervention.
The scope of the practice issue
The issue of discharge planning that involves the development of a personalized care plan is a global one. The major goal of discharge planning and its personalization is the improvement of patient outcomes in post-discharge period as well as ensuring the appropriate care before the discharge. This issue also presupposes that the patient does not leave the hospital earlier that appropriate for his or her condition and receives the necessary post-discharge services.
On the whole, personalized plans are expected to reduce both the length of stay at hospitals and readmission rates. Another problem is the lack of patient monitoring after discharge, which can lead to unsatisfactory patient outcomes since not all patients can properly evaluate their condition or provide effective self-care. Thus, the implementation of telehealth, which is a service providing distant patient care, intervention, education, and monitoring, can increase patient safety and reduce readmissions for patients with CHF.
The practice area
The practice area is clinical.
How the practice issue was identified
- Safety/risk management concerns
- Unsatisfactory patient outcomes
- Clinical practice issue is a concern
The practice issue deals with patient safety and risk management because the implementation of personalized discharge plans allows both increasing patient safety and reduction of the risk for readmission. Unsatisfactory patient outcomes can be a direct consequence of wrong discharge instructions and the lack of monitoring in the post-discharge period. Finally, it is a clinical practice issue since discharge and its planning is an integral part of the patient’s staying in the clinical setting.
Evidence that must be gathered
- Literature search
- Patient Preferences
To develop a personalized discharge plan, it is necessary to investigate previous studies on the issue. Thus, literature search is useful to collect evidence. Moreover, patient preferences can be studied to define their needs in post-discharge period and include them in the plan.
Evidence Summary
The practice problem
The practice problem is discharge planning for patients with CHF. The target population comprises patients older than 45, that is older adults. The setting for the problem is a hospital. The magnitude of the problem comprises the length of hospital stay and readmission rates for patients with CHF.
The objectives of the related systematic review article
The main objective of the article is to provide a systematic search for studies (trials) to find evidence of the impact that personalized discharge plans have on patients who leave the hospital.
The questions being addressed in the work and in relation to the practice issue
The questions addressed in this work are as follows:
- Does a personalized discharge plan positively contribute to the length of stay at hospital?
- Does the implementation of a personalized plan decrease readmission rates?
- Does discharge planning decreases healthcare costs?
Both questions are related to the practice issue and the formulated PICOT question which aims to discover the impact of Telehealth service as a part of discharge plan for patients with CHF on the rates of hospital readmissions.
The interventions the authors suggest to improve patient outcomes
The primary intervention was to compare the use of personalized discharge plans for patients who leave the hospital and standard discharge care.
The main findings by the authors of the systematic review including the strength of evidence for each main outcome
The study resulted in the following findings. First of all, it revealed a small reduction in the length of stay at hospital (mean difference 0.73, 95% confidence interval – 1.33) (Gonçalves-Bradley et al., 2016). Readmission rates also proved to be lower for elderly patients after three months of discharge (RR 0.87). However, these findings are not supported by evidence from the research by Ong et al. (2016), which did not prove the influence of remote patient monitoring after discharge on readmission rates within 30 and 180-day period. However, this intervention as a part of a discharge plan had a positive impact on the quality of life (Ong et al., 2016).
Evidence-based solutions for the project
First of all, personalized discharge plans can be used as an intervention in the project. They will include Telehealth as a service to support the patients and control their condition. Secondly, it is necessary to evaluate the effectiveness of Telehealth service because a similar intervention had no impact on readmission rates of CHF patients.
Limitations to the studies
The reviewed studies have some limitations for utilization in the project. First of all, not all studies included in a randomized trial had patients with CHF as a sample. Secondly. The systematic review did not mention Telehealth as one of the possible discharge plan interventions.
References
Gonçalves-Bradley, D., Lannin, N., Clemson, L., Cameron, I., & Shepperd, S. (2016). Discharge planning from hospital. Cochrane Database of Systematic Reviews. Web.
Ong, M., Romano, P., Edgington, S., Aronow, H., Auerbach, A., & Black, J., … Fonarow, G. C. (2016). Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure. JAMA Internal Medicine, 176(3), 310-318. Web.