Introduction
Hospital readmissions among patients with congestive heart failure (CHF) are a rising cause of global concern among health care professionals and government agencies (Ogbemudia & Asekhame, 2016). Increased hospital readmissions continue to place a high burden on patients who suffer from physical pain and mental health, treatment costs, health insurance premiums, and hospital resources (Sukul et al., 2017). In the United States, the 30-day readmission rate for patients with CHF rose from 17% in 1993 to 20% in 2006. Patterns of hospital readmission are linked to the length of hospital stays, clinical factors, age of the patient (geriatric patients are most affected), and impacts of comorbidities. Hospital readmission rates pose significant health challenges and hospital-based strategies show reduced effect in curtailing the problem. Recent trend shows increased uptake of patient-centered strategies such as the inclusion of technology through telemonitoring measures. Among patient-centered strategies to reduce readmission rates among patients with CHF is the use of the validated transitional care protocol in nursing facilities.
Proposed Question
Congestive heart failure (CHF) places a heavy economic and social burden on health care systems, especially relating to hospital readmissions (Storm et al., 2014). Older adults are most affected because of the lack of consistency in implementing health plans and poor understanding of treatment plans, nonadherence to medical therapy, irregular follow-up with health professionals, and lack of awareness of CHF symptom exacerbation. Thus, there exists a need for the implementation of a patient-centered validated tool to help in the improvement of the quality of health services to older patients with CHF. The PICOT question formulated for the research study is as follows: Among geriatric patients diagnosed with CHF in a skilled nursing facility (P), what is the efficiency of implementing a validated transitional care protocol for preventing hospital readmission (I), compared to usual care protocols for preventing re-hospitalization (C), in reducing 30-day CHF readmission (O), within two months (T)? thus, the study focuses on collecting and appraising evidence on the use of the validated transitional care protocol to assess its applicability and efficiency in use to reduce re-admissions among geriatric patients with CHF.
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Evidence from Research and Theory
Plakogiannis and others (2019) showed that the implementation of a patient-centered transitional care strategy among patients with CHF helped in reducing the rate of readmissions in hospitals. The authors conducted a retrospective manual chart review study for patients with CHF who had been categorized as high-risk for hospital readmissions. The hospital involved in the study used a team of health professionals drawn from multiple disciplines to conduct follow-up interview questions with patients. The health professionals discussed with the patients through telephone to assess various aspects of care including indications for therapy, dose adherence, duration, evaluating adherence to physician appointments, and reinforcing signs of fluid overload. The pilot program lasted six months and the authors noted that the 30-day hospital readmission rate for CHF patients after the introduction of the transitional care program fell from 24.43% to 11.45%. The results from the pilot study were supported by 90-day readmission rates which fell from 38.17% to 22.90%, showing that the implementation of a transitional care program helps to reduce hospital readmission rates for patients with heart failure.
Doris and others (2015) assessed the effects of nurse-implemented transitional care for individuals with CHF in Hong Kong. The authors used a modified version of transitional care strategies and conducted a randomized control trial university-affiliated study involving patients diagnosed with CHF. After screening and including 178 individuals for the study, nurses implemented the intervention strategy which included pre-discharge visits, home-care-based visits, follow-up through phone calls, and the provision of a cardiac nurse for evaluation. The overall intervention included the assessment of the health status of patients, assessment of disease progress, customization of educational and supportive interventions, skills training to patients, review, and adjustment of self-care goals, provision of advice to patients, and monitoring CHF symptom severity. The results of the study showed that the implementation of transition care strategies lowered hospital readmission rates at 8.1% compared to the usual care grou
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