Introduction
A lot of issues related to nursing are discussed nowadays, but hospital readmissions of patients within 30 days of discharge seem to be among the most crucial ones because it means that the interventions they received in a hospital failed to improve their health condition as expected. Rather often the main reason for discharge is the fact that ED is too busy. Healthcare professionals resort to it, trying to make more beds available. In this way, they overlook important information and maintain unsafe discharges unwillingly. Patients’ safety concerns increase, as more adverse health outcomes are observed. In order to resolve this issue, professionals should start using a pre-discharge checklist and maintain follow-up calls after discharge. In this way, nurses will know if all patients’ needs are met before they leave.
Change Model Overview
Realizing that the problem exists, nurses should implement changes in the framework of the ACE Star model Evidence-Based Practice Process. This model can be used to facilitate an alteration because it is a simple way of aligning knowledge and practice. Thus, nurses should:
- Discover knowledge related to the issue;
- Collect evidence;
- Develop a guideline for clinicians on the basis of this information;
- Integrate a change;
- Evaluate outcomes.
As a result, nurse practitioners are likely to base their decision on the most relevant information.
Define the Scope of the EBP
People mainly resort to healthcare facilities when they have critical health issues and require assistance. They expect that they will be able to live normal lives after a discharge and get frustrated and dissatisfied with the provided services when such outcomes are not observed. Moreover, hospital readmissions may presuppose that their condition worsens. Researchers reveal that “4 to 6 weeks post discharge represents a critical period when many elders are at highest risk for poor discharge outcomes’ and empirical research in a mixed population has shown that post discharge problems are greater at 7 days post discharge than at 30 days post discharge” (Mistiaen & Poot, 2006, p. 3). What is more, 15.2% of all patients face readmissions. Treating the same patients several times, nurses spend much time then they might spend if avoiding unsafe discharges and readmissions, which affects the health condition of the whole society adversely.
Stakeholders
In order to conduct this research, several professionals will be approached, including nurse practitioners, nursing students, and nursing researchers.
Determine Responsibility of Team Members
The chosen stakeholders are extremely significant to the project because they streamline all related operations. To maintain a research study, nurse practitioners should be involved due to the necessity to test the effectiveness of the checklist. They also can assist with telephone phones’ if not, help can be provided by nursing students who are interested in the topic. They will be knowledgeable enough to understand what to ask and to summarize obtained data. In addition, it would be advantageous to involve another researcher who will be able to process the information and ensure that the leader does not overlook any important data or critical mistakes.
Evidence
Due to the maintained research, a lot of related information was obtained. Evidence-based practice (EBP) guidelines were found for one of the interventions used to reduce readmissions. The article included the questions that should be asked and the methods used for the analysis of the obtained information. In addition to that, the advantages of a pre-discharge practice for nurses were mentioned.
Summarize the Evidence
The information obtained from the systematic review article revealed that follow-up calls after discharges have positive influences on hospital readmissions (Mistiaen & Poot, 2006). The authors focused on the psychosocial needs of patients, and found out whether care was maintained properly or not. They also received an opportunity to consult clients if they had some questions, which provided the patients to improve the situation themselves.
Develop Recommendations for Change Based on Evidence
On the basis of the conducted research study, it can be claimed that nurse practitioners should try to use two beneficial interventions in their practice in order to reduce hospital readmissions. First of all, the utilization of a pre-discharge checklist for nurses is recommended. With its help, all needs for every patient can be met before they leave a hospital. As a result, the relations between patients and nurses are also likely to improve significantly. The rest of the medical team should also experience positive alterations due to the improvement in this area. The reduction of the number of readmissions can be achieved with the help of follow-up calls as well, because they provide an opportunity to receive clients’ feedback and educate them on its basis.
Translation
Action Plan
In order to implement this pilot study, the researcher will gather knowledge related to the issue and develop a plan of actions on its basis. Then, one will approach the health care facility and ask nursing professionals for permission to practice a proposed change. The sample that includes patients of this hospital will be gathered. The nurse professionals will be asked to utilize provided analysis with checklists. The information will be gathered and analyzed. In a couple of weeks, the researcher and his/her assistants will contact these patients and conduct follow-up calls. The number of readmissions in 30 days will be counted in the framework of the sample.
Process, Outcomes Evaluation, and Reporting
It is expected that the proposed interventions will reduce hospital readmission rates significantly, proving that they have a positive influence on patients’ health outcomes. The effectiveness of the interventions will be measured when comparing obtained data with the readmission rates previously observed by nurse professionals. The result will be reported to the key stakeholders with the help of e-mails.
Identify Next Steps
The proposed plan can be implemented on a larger scale. Nurse practitioners can use pre-discharge checklists with no complications, making them a part of the everyday practice. However, follow-up calls may turn out to be rather time-consuming if the number of a sample increases significantly. Then, it may be better to maintain communication with the help of the Internet. Nevertheless, the proposed plan can be used by other units or the facility as a whole. It is not based on the problem itself, which makes it rather universal and easy to use. For this implementation to become permanent, it should be included in the hospital’s policy.
Disseminate Findings
The findings will be communicated internally through the oral report. The same information will be available when the article is published, so people outside of the organization will learn the most critical information about them.
Conclusion
Hospital readmissions are a critical nursing issue that reveals the fact that they fail to receive needed care and their problems remain critical to their health condition. Fortunately, unsafe discharges that lead to this problem can be avoided if nurse practitioners start using pre-discharge checklists and after-discharge follow-up calls. To maintain the change plan, the researcher should search for knowledge related to the issue and collect associated evidence. On its basis, a guideline for professionals should be developed. Finally, recommended changes should be integrated and evaluated for their effectiveness to be proved.
Reference
Mistiaen, P., & Poot, E. (2006). Telephone follow-up, initiated by a hospital-based health professional, for post discharge problems in patients discharged from hospital to home. Cochrane Consumers and Communication Group, 4, 1-18.