Practice Issue
The topic
The topic for the project is the use of Telehealth monitoring system for patients with congestive heart failure to check its impact on the reduction of readmission rates and an increase in treatment compliance. Since the Telehealth monitoring system is a part of discharge planning, the systematic review selected for the project is dedicated to discharge planning from hospital. Another research to support the project is the study investigating rehospitalization for heart failure (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013).
The nursing practice issue related to the topic
Nursing practice issue for the selected topic is the improvement of CHF patient outcomes, reduction of readmission rates, and increase in compliance due to the use of Telehealth monitoring system. According to ACE Star Model of knowledge transformation, the practice issue can be defined in the following way. The first stage is discovery or research. During this stage, the problem, which is the reduction of CHF patient readmission, is investigated.
During the second stage, evidence obtained are summarized. For the next stage, guidelines are translated and the plan for Telehealth system is developed. At stage four, the plan is integrated into practice. The final stage includes the evaluation of outcomes, which means that the effectiveness of Telehealth system will be assessed and its impact on readmission rates and treatment compliance after discharge will be measured.
The scope of the practice issue
Readmissions to hospitals for heart failure is a frequent case on the whole and for elderly patients in particular. Heart failure itself is the most common reason for hospitalization among patients older than 65 (Gheorghiade et al., 2013). Rehospitalizations create a financial burden on healthcare providers and health insurers. Therefore, there is a need for interventions that can reduce readmission rates and improve the patient outcomes. Telehealth monitoring system provides an opportunity to support CHF patients during their post-discharge period, provide them with information about the necessary self-care, and monitor their condition. the system can be included in the discharge plan for CHF patients thus increasing their chance for favorable outcomes.
The practice area
- Clinical
- Education
How the practice issue was identified
- Safety/risk management concerns
- Unsatisfactory patient outcomes
- Significant financial concerns
This practical issue is related to safety concerns and risk management since readmission to hospital with CHF increases the risk of complications. Also, the project can improve patient safety. The issue of unsatisfactory patient outcomes is also connected with the project because rehospitalization frequently results in longer stay at hospital and can have a negative impact on mortality rates. Finally, this practice issue implies significant financial concerns because readmissions demand additional costs from insurers and healthcare providers.
Evidence that must be gathered
- Literature search
- Guidelines
- Expert Opinion
The necessary evidence can be collected from scholarly literature through literature search. Also, it is necessary to review guidelines about discharge planning and the possibility of including Telehealth system to this plan. Finally, expert opinion can be useful to predict the project outcomes and foresee the challenges.
Evidence Summary
The practice problem
The practice problem is a high level of readmission for CHF patients. The population is mainly elderly people older than 65. The setting is a cardiac unit of a hospital. The aspects of the problem that can be measured include readmission rate and treatment compliance among post-discharge patients 90 days after discharge.
The objectives of the related systematic review article
The objectives of the article are as follows:
- Assess the efficiency of individualized discharge planning
- Check if discharge planning can improve the application of acute care
- Check if discharge planning can improve patient outcomes
- Check id discharge planning can reduce healthcare costs.
The questions being addressed in the work and in the relation to the practice issue
The questions addressed in the work are the impact of discharge planning on the length of stay at hospital, readmission rate, and cost of care. The question related to the project topic is that of reduction of readmission rate.
The interventions the authors suggest to improve patient outcomes
The authors suggest that personalized discharge plans can improve patient outcomes and result in the reduction of readmission rates as well as shorten the length of stay at hospital.
The main findings by the authors of the systematic review including the strength of evidence for each main outcome
The research findings are based on data from 30 studies and thus can be considered reliable. The research revealed a tendency to a small reduction of hospital stay among patients with individualized discharge plans compared to those who received regular care. Another discovery is the reduction of readmission rates. This finding is relevant to the project. Another finding is an increase in patient satisfaction due to the use of personalized discharge plans.
Evidence-based solutions for the project
The solutions grounded on the evidence from the research applicable to the project are as follows. An individualized discharge plan has a positive impact on readmission rates and thus can be applied to CHF patients. Another opportunity provided by individualized planning is inclusion of interventions that can be effective for every patient, for example, the introduction of Telehealth monitoring system.
Limitations to the studies
Despite the useful solutions suggested by the studies, they have some limitations for their application to the project. First of all, the systematic review does not evaluate the interventions that can be included into a discharge plan and thus does not help to predict the effectiveness of using Telehealth system. The limitation of the study by Gheorghiade et al (2013) is that it does not contain data about discharge planning.
References
Gonçalves-Bradley, D., Lannin, N., Clemson, L., Cameron, I., & Shepperd, S. (2016). Discharge planning from hospital. Cochrane Database of Systematic Reviews. Web.
Gheorghiade, M., Vaduganathan, M., Fonarow, G., & Bonow, R. (2013). Rehospitalization for heart failure. Journal of The American College of Cardiology, 61(4), 391-403. Web.