PICOT Population/Patient

Adults with congestive heart failure requiring hospitalization

Intervention

Heart Failure education (signs, symptoms, pathophysiology), self-care interventions (diet, fluid restrictions, sodium dietary restrictions, review of medications, exercise recommendations, weight monitoring), patient support (telephone support, increased clinic visits, home visits, social support, psychological support, multidisciplinary care).

Comparison

Usual care vs. intervention, one intervention vs. another intervention

Readmission rates (all causes), length of hospital stay, health care utilization, mortality rates (all causes), quality of life.

Timeframe

One Month follow up

Question

In congestive heart failure patients 50 years and older, what is the effectiveness of interventions to support post-discharge care compared with the usual care to prevent readmission?

How can we prevent readmissions for patients with congestive heart failure?

Introduction

Congestive Heart Failure (CHF) occurs when the heart is unable to pump enough blood flow to meet the needs of the body. It can cause a number of symptoms, including shortness of breath, exercise intolerance, swelling in the extremities, numbness, and even mimic the symptoms of gastric distress. Treatment is dependent upon severity of the affliction, whether chronic or first-incidence. Sometimes, treatment is environmental in nature (loss of weight, increased exercise, decrease in smoking, etc.), other times it is treated with implanted devices, blood thinners, or medication. Heart failure in the developed world is relatively common due to more sedentary lifestyles, with about 2% of the population suffering from the disease, but 10-12% of those over 65 (McMurray & Pfeffer, 2005; Hines, Yu, & Randall, 2010). Because HF is so common, we must also look upon it as an epidemic that may have...

Nurses need to educate patients on diet, recording weight and blood pressure, and suggesting alternatives in exercise. Doctors need to ensure that these patients come in for regular visits; 1 week, 4 weeks, monthly for the first 6 months, then quarterly for the next 24 months (Crowther, 2012). The key to a successful implementation seems to be the robust involvement of the nurse in two specific areas: managing the educational procedure and follow-up with the patient on ways to improve self-care. If just these two steps are implemented, there are considerable decreases in readmission and savings in the overall healthcare system. The more intense and robust the nursing intervention, the more cost savings (Andrietta, M., et al., 2011). The teach-back method has proven quite effective when implementing any plan. This technique has helped one hospital reduce readmission rates for CT by 12%. This method provides the opportunity to allow the patient to repeat back instructions or educational concepts in their own words; this allows the healthcare professional to assess patient understanding; then allows a way to rephrase and/or retrain when gaps are discovered (Bradke & Brinker, 2011).
Change Plan

One model, the Rosswurm and Larabee, puts research utilization as a primary component of change management. It is a six step model that may be implemented once evidence is gathered and is really designed to be a three part change model: 1) Steps 1 and 2 -- Identification and link of issue; 2) Step 3 synthesizes the quantitative and qualitative research studies; 3) Steps 4-6 design and implement an action plan…