Practice Issue
The topic
In asthmatic children who are repeat patients at a healthcare facility and do not have a discharge plan, does the development of a discharge plan decrease the readmission rate by 10% within three months?
The nursing practice issue related to the topic
The nursing practice issue related to the chosen topic is discharge planning. According to Hesselink et al. (2014), discharge planning aims at helping patients to move from inpatient care to home settings while reducing the probability of an adverse event. Failure to provide a successful discharge plan, on the other hand, can lead to unwanted health consequences and increase the risk of exacerbations leading to readmission (Hesselink et al., 2014). Thus, discharge planning is an essential issue in nursing practice.
The scope of the practice issue
Ideally, discharge planning begins upon the patient’s admission to the healthcare facility. Physicians, nurses, patients, and their families, are all involved in discharge planning and are at least partly responsible for health outcomes post-discharge. Discharge planning should be performed for all patients admitted to the facility and includes patient education, prescription of medication, and follow-up appointments, as well as an assessment of the condition and the patient’s needs. In asthmatic children, the education of parents or caregivers is critical to promoting the continuity of care and thus can help to reduce readmission rates.
The practice area
The practice area is clinical.
How the practice issue was identified
- Unsatisfactory patient outcomes
- Wide variations in practice
The practice issue was identified due to unsatisfactory patient outcomes and noticeable variations in practice. First of all, it was noted that asthmatic children admitted to the hospital had high readmission rates within three months of discharge. Secondly, observing the behavior of physicians and nurses working with asthmatic children who are repeat patients at the facility showed significant individual variations in the approach to discharge planning. Whereas some health professionals issued comprehensive instructions and spent time with parents to ensure that the plan is clear, others introduced the plan very briefly.
Evidence that must be gathered
- Literature search
- Guidelines
- Other: Readmission rates for repeat patients
In support of the PICOT project, it will be necessary to collect two types of evidence: research articles and guidelines. A thorough review of the literature on the topic could shed light on the relationship between discharge planning and readmission rates. Official guidelines, on the other hand, could highlight evidence-based discharge planning practices. Besides, it would be useful to obtain medical information from the institution, including readmission rates for the chosen patient population. As a whole, the three types of evidence listed above would help to provide a reliable answer to the PICOT question stated, as well as outline the fundamental recommendations and practices that could increase the effectiveness of discharge planning in reducing readmission rates.
Evidence Summary
The practice problem with reference to the identified population, setting, and magnitude of the problem in measurable terms
Discharge planning is an essential process that should provide guidelines and information critical to helping patients return home without interrupting the prescribed health care regimen. In children living with asthma, adverse events can be triggered if the continuity of care is interrupted. Thus, physicians and nurses providing discharge plans should take the time to provide sufficient education to parents and encourage compliance with the plan of home care. The primary setting of the practice issue is thus the hospital, from which the patient is being discharged. However, due to the specific features of the issue, the home becomes a secondary setting and thus should also be taken into account. The main measure of the magnitude of the problem is the readmission rates for asthmatic children who are repeat patients at the target facility.
The objectives of the systematic review article
The main objective of the article was to compare the effectiveness of nurse-led asthma care and physician-led asthma care in primary care and hospital settings. The secondary objectives were to determine the methodological quality of existing studies on the subject and review the incidence of exacerbations after inpatient treatment.
The questions being addressed in the work and how they relate to the practice issue
The work addresses two key questions:
- What is the effectiveness of nurse-led asthma care compared to physician-led asthma care in primary care and hospital settings?
- What are the factors affecting the incidence of asthma exacerbations post-discharge?
The first question relates to the chosen topics as it can help evaluate the project’s recommendations on discharge planning. As noted, current discharge planning procedures are performed by both nurses and doctors; however, if the study shows no negative variations in the effectiveness of nurse-led care versus physician-led care, it might serve as evidence to suggest that nurses should be responsible for developing discharge plans for patients. The second question can aid in connecting adverse patient outcomes to poor discharge planning.
The interventions the author(s) suggest improving patient outcomes
The authors suggest that nurse-led care should be used in patients with well-controlled asthma to improve health outcomes.
The main findings by the authors of the systematic review, including the strength of evidence for each main outcome
The outcome studied by the researchers is the effectiveness of care. The study showed no statistically significant variations in the efficiency of nurse-led care as opposed to traditional physician-led care. The authors identify that the evidence used is of high quality. The results contribute to the recommendations for improving discharge planning provided as part of the project paper. Similarly, the study by Hesselink et al. (2014) can be applied in support of evidence-based discharge planning procedures.
Evidence-based solutions to consider for the project
The project will consider evidence-based solutions, including using intervention mapping (Hesselink et al., 2014) and involving nurses in discharge planning for patients with well-controlled asthma (Kuethe et al., 2013).
Limitations to the studies that impact the ability to utilize the research in the project
The main limitation of the study by Kuethe et al. (2013) is that it does not focus on discharge planning as a predictor of readmission or adverse events. Thus, its impact on the project will be quite limited. On the other hand, the study by Hesselink et al. (2014) primarily targets patient handover from hospital to primary care; thus, different solutions may be required for patients being discharged from the hospital to go home.
References
Hesselink, G., Zegers, M., Vernooij-Dassen, M., Barach, P., Kalkman, C., Flink, M.,… Suñol, R. (2014). Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC Health Services Research, 14(1), 389-399.
Kuethe, M. C., VaessenâVerberne, A. A., Elbers, R. G., & Van Aalderen, W. (2013). Nurse versus physicianâled care for the management of asthma. Cochrane Database of Systematic Reviews, 2(1), 1-35.