NR 447 Week 5 Discussion – Patient Outcomes

NR 447 Week 5 Discussion – Patient Outcomes

As a BSN-prepared nurse, I have been asked to serve as a consultant to suggest a new Quality Improvement for ONE of the areas of deficiency in a hospital. According to the United States Department of Health and Human Services (2011), quality improvement (QI) “consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups” ( Hain, 2017). This is a process that requires evaluation, training, and continuing education of the staff of each institution. I think, in the first place, I would identify the underlying types and causes of readmission. In my short experience as an RN, I consider that late communication with the patient after he was discharged as well as not doing medication reconciliation after discharge, constitutes quite frequent causes of readmission. I think we should start planning our discharge from the moment of admission. As nurses, it is important to teach and explain to the patient the details of their illness and the steps to be taken to achieve a complete recovery. What should you do at home? If you have the assistance or help of a family member? it would even be ideal for making a follow-up appointment for this patient with their primary doctor before the patient leaves the hospital, since in most cases, even when the instructions say they should go to see the primary doctor, patients do not contact their primary physician.

Assessing and improving care is not a static process, and changes continue, as do problems. The road to improving health care is not a smooth one and includes successes, failures, and mediocrity. The complex, fragmented, and disorganized healthcare system is ineffective in dealing with these problems. In 2014, a major decision was made by the Centers for Medicare & Medicaid Services (CMS) to begin paying physicians a monthly fee for the coordination of care for patients with chronic illnesses, effective January 2015 (Finkelman, 2016).

In the company where I currently work, there is a well-organized policy, in my opinion, to avoid readmission to the hospital. When a patient returns to the hospital within the first 30 days, the goal is to keep the patient out of the hospital. Part of my duties as a health coach is to know our Medicare patients, including our high-risk patient population. In this company, we stratify this population of patients in bands based on the comorbidities of the patients, such as diabetes mellitus with some complications, heart failure, chronic obstructive pulmonary disease, cancer, or dementia. These are banned on a scale of one to five, with five being the higher-risk patient. The patient’s band stratification determines how often the patient should be contacted or seen in the office. For example, if a patient’s that are a band five should be seen in the office every two weeks, and I should call them every week. The reason for this call is to follow up on their symptoms, medications, and whether they need some help or assistance.

NR 447 Week 5 Discussion – Patient Outcomes

If the patient is admitted to the hospital, we keep secure email contact with our inpatient case manager for updates, and also, our providers communicate directly with the hospitalist in the hospital to work together as a team for the best outcome for the patient. Days before discharge, with the support of the inpatient case manager, we set up an appointment for the hospital’s follow-up visit in our clinic. We always try to make this visit within the first seven days after discharge. Once the patient has been discharged, it is my responsibility to call them within the first three days after discharge. The purpose of this call is to review the reasons the patient was admitted to the hospital and also to reconcile the medication that was prescribed at the time of discharge. Many of these readmissions are caused by ignorance, fear, or lack of understanding of the instructions explained in the hospital at the time of discharge. During this phone call, I will also verify that the patient does not have any adverse reactions to any of the newly prescribed medications if there are any. I will additionally verify that our patients do not need any services such as home health assistance, DME, or social services. We also confirm with the patient their next follow-up appointment with the date and time, and if transportation is needed, I will assist the patient and set up transportation that my company provides.

We also use a LACE score tool to predict the risk of repeating hospital readmission in the next 30 days. This tool uses four variables to predict the risk of death or non-selective 30-day readmission after hospital discharge among both medical and surgical patients: length of stay (L), acuity of the admission (A), comorbidity of the patient (C) and emergency department use in the duration of 6 months before admission (E) (Robinson and Hudalihe, 2017). This helps the provider with an objective assessment of the patient. If a patient scores higher than an 11, they are considered at high risk of readmission, and the patient is seen in the office three times within the first 30 days.

NR 447 Week 5 Discussion – Patient Outcomes

In my experience as an RN working in a managed care clinic setting, the contact with the patient within the first three days after discharge as well as the follow-up consultation within the first seven days is a key element to avoid readmissions. My biggest challenge with these phone calls is that some patients do not want to be contacted or come to the office because they are feeling better. That’s why I feel that quality improvement is a process that does not happen in a day but takes time and perseverance as well as real teamwork.

References

Hain, J. D. (2017). Exploring the Evidence. Focusing on the Fundamentals: Comparing and Contrasting Nursing Research and Quality Improvement. Nephrology Nursing Journal. 44(6), p541-544. Retrieve from

https://eds-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail? vid=3&sid=30bd96d8-1bcd-4ceb-9bec-5abac1985aef%40sdc-v- sessmgr02&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d %3d#AN=126986366&db=c9h

Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.

Robinson, R., and Hudali, T. (2017). The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital. PeerJ, 5:e3137. DOI: 10.7717/peerj.3137

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As a BSN prepared nurse, you have been asked to serve as a consultant to suggest a new Quality (Performance) Improvement process for ONEof the areas of deficiency. Write some brief steps (suggestions) for improvement as you contemplate accepting the consulting opportunity.
Share practice improvements utilized from your own clinical nursing experiences that have led to enhanced patient outcomes.