Nightingale Only : I need help with my Research Paper

Running head: DISCHARGE PLANNING AND HOW THIS IMPACTS PATIENT OUTCOME 0

Discharge Planning and How This Impacts Patient’s Outcome

NR449: Evidence-Based Practice

May 2017

Clinical Question

This paper addresses the problem where patients are discharged only to be readmitted back to the hospital. Determining how discharge planning can help to reduce the cases of readmission, which tends to contribute to reducing the cost the clients incur. Avoidance of hospital readmission is one of the vital effects that help guarantee patient safety and quality concerns. Readmission within a short period after a patient has been discharged is very common and cost effective when it comes patients who are chronically ill (Graham, et al., 2013). Statistics that were analyzed between 2013 to 2015 showed that 19.6% of Medicare beneficiaries were readmitted to the hospital within 30 days after they were discharged. On the other hand, 34% of the patients were readmitted within a 90 days period (Hansen, et al., 2013). Medical and surgical patients were the most affected. Furthermore, the medical patients were the ones with the highest readmission rates, 21.1% compared to 15.6% surgical patients. Also, a 30-day readmission was observed among patients with heart failure accounting for 26.9%. Followed by mental health patients at 24.6%, then patients who had had vascular surgery at 23.9%. Close to this were patients with chronic obstructive pulmonary disease at 22.6% and lastly pneumonia at 20.1% (Hansen, et al., 2013).

The significance of this problem is that proper planning before discharge will help in reducing the rate of readmission among clients. A very close review has been done in efforts to reduce the rates of readmission of clients that were discharged earlier (Graham, et al., 2013). Recent studies have also, been done on how to reduce the readmission of hospitalized patients (Graham, et al., 2013). One is the improvement of patient safety when the patient is being discharged from the hospital (Gonçalves‐Bradley, et al., 2016). Also, enhancing a medication reconciliation (Gonçalves‐Bradley, et al., 2016). Moreover improving on the handing over of a patient from being an inpatient to an outpatient (Graham, et al., 2013). Further publications are also in place highlighting the role that is played by the ambulatory care that helps in fostering transitions that are more efficient in providing care to a client.

The PICOT question in support of my group topic is: Can discharge planning from acute care compared with the lack of discharge planning reduce readmission and the costs of health care for clients?

Population-Acute care patients

Intervention-Discharge planning

Comparison-Lack of discharge planning

Outcome-Reduced readmission and costs

Time-1 month after discharge

In this research, the independent variable is discharge planning while the dependent variable is decreased readmissions and costs. The population is the hospitalized patients being discharged from acute care management. The expected outcome is to reduced readmissions and costs to the patients. The time variable is approximately one month after discharge because we expect the acute care patients to have a good prognosis.

The purpose of this paper is to identify evidence-based practice to help come up with a solution to the high cases of readmissions of patients that had been admitted previously and discharged afterward.

Levels of Evidence

The quantitative clinical question focused on how discharge planning can help in reducing the readmission of a client and reducing the cost incurred by a client in seeking health care. The question mainly asked is it a quantitative research question. For this paper, the type of quantitative research question is descriptive and causal. In descriptive, it tries to explain the reason that leads to readmission of patients after having been discharged from the hospital. On the other hand, the causal question tends to focus on whether one or more variable. The more of a variable causes some effect on the outcome. In this case, poor planning is the likely cause that can lead to increased cases of readmission and even higher cost incurred by the client.

Search Strategy

The key terms that I used to search include; discharge planning and reduce readmission. The database I used is MEDLINE and Cochrane, and the first word that I searched was discharge planning. I was able to come up with 4,254 results from this search. This was followed by the search reduce readmission, and I was able to get 6,322 results. I combined the two phrases into discharge planning to contribute to reducing readmission, and I was able to come up with 231 results. To get an advanced search, I typed for publications between 2013 to 2016, and I was able to come up with 18 articles, which included readmission cases with various health conditions including both medical and surgical cases. When I further went ahead to search for reduced cost of clients I came up with 3,221 results. However, when I combined the keywords; discharge planning, reduced readmission and lower cost, I failed to get any result. This made it hard for me to come up with the articles that were particular on discharge planning in reducing readmission and the cost of healthcare for clients. To overcome this, I decided only to use the keywords, discharge planning and reduce readmission.

With the findings found from the searches, I was able to conclude that improvement of patient safety during discharge, enhancing medical reconciliation, and improved integration of client from being inpatient to outpatient are the major things that can help prevent client complications from taking place (Graham, et al., 2013). The other article focused on educating the patient on how to take care of themselves better, a follow-up visit with a healthcare provider and medication compliance. Health coach and integration of nurses in care participate by interacting with the client both before and after discharge (Gonçalves‐Bradley, et al., 2016).

References

Gonçalves‐Bradley, D. C., Lannin, N. A., Clemson, L. M., Cameron, I. D., & Shepperd, S. (2016). Discharge planning from hospital. The Cochrane Library.

Graham, J., Gallagher, R., & Bothe, J. (2013). Nurses' discharge planning and risk assessment: behaviours, understanding and barriers. Journal of clinical nursing, 22(15-16), 2338-2346.

Hansen, L. O., Young, R. S., Hinami, K., Leung, A., & Williams, M. V. (2012). Interventions to reduce 30-day rehospitalization: a systematic review. Annals of internal medicine, 155(8), 520-528.

1