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One of the key reasons that was found to be a factor in readmissions is that insurance companies continue to push for shorter hospital stays. They have reduced the number of days that they will pay for certain conditions. This was found to be a key factor in releasing patients early, when they might have benefited from a longer hospital stay (Bueno, oss, & Wang et al., 2010; Capelastegui, A,, Espana, P., & Quintana, J. et al., 2008), This factor will have to be considered as a potential barrier to the study. It may be that insurance companies and Medicaid/Medicare reimbursements are a factor in early release of patients rather than hospital practices.
Factors that were identified in other studies of hospital 30-day readmissions included the presence of deep vein thrombosis and pulmonary embolism (Spencer, Gore, & Lessard et al., 2008). Severity scores such as those for community-acquired pneumonia were…… [Read More]
causes for Medicare and Medicaid patients to be readmitted to hospitals within thirty days of a prior discharge. This is a fairly pervasive and major problem and it is one that demands solutions. As part of this capstone, there will be a number of facets and tools used. There will be a problem description that identifies what the problem is and why it is important. There will be a solution description that broadly asserts what is needed to address and resolve the problem identified. There will be an implementation plan that will lay out how the program will be rolled out to the locations and the people that work therein. There will also be an evaluation plan that will be used to monitor and assess performance so that any deficiencies can be spotted and addressed before they become full-on conflagrations that can sap the performance and outcomes of the project.…… [Read More]
Hospitals with more elderly, poor patients likely to face readmission penalties" by Katie Sullivan (January 8, 2014)
Are some hospitals discharging patients before they are ready, causing them to be subsequently readmitted? This would seem to be the issue involved in the recent decision by the federal government to assess penalties if hospitals treat so-called "dual-eligible seniors," or those eligible for medical care under both Medicare and Medicaid, because these patients are at higher risk of readmission within 30 days of discharge. According to an article by Sullivan (2014), the reality of the situation is that the majority of the hospitals that will be adversely affecting by this decision are those whose treatment area contains inordinately higher percentages of senior citizens who require a greater share of healthcare resources compared to their younger counterparts. Moreover, the quality of care being provided in these hospitals is not generally at issue. In…… [Read More]
Amin, B et al. (2013). Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. Journal of Neurosurgery: Spine, 18(2): 134-138.
This study examines the University of California's Medical Center in San Francisco in order to determine if its all-cause readmission rates accurately reflect the readmission rates for spine injury patients. The secondary purpose of the study is to identify readmission predictors. The researchers collected data from 5780 consecutive patient visits. 5% of the visitors were readmitted within a month of their discharge. The researchers examined variables that led to their readmission and regression analysis was conducted in order to spot predictors. A t-test was also used to see if there was any difference in admission vs. non-readmission incidents. The researchers found that infection was the number one variable leading to readmission, inoperable management the second most common variable, and planned surgery the third most common variable for…… [Read More]
eadmission of patients with diabetes is a problem that warrants consideration of the contributing factors. eadmission of patients within 30 days of discharge is considered to be an indicator of healthcare quality -- along with other circumstances, such as patient lifestyle -- that needs to be addressed from a patient care perspective and from a cost of care perspective (Dungan, 2012). A dismal statistic starkly represents the problem: oughly 8% of the U.S. population is represented by patients with diabetes, yet this group accounts for 23% of the hospitalizations in the nation (Dungan, 2012). On top of this figure, between 14.4% to 21% of diabetic patients are readmitted, compared to 8.5% and 13.5% of U.S. hospital patients overall (Dungan, 2012). The problem is exacerbated by the rise in national rates of diabetes means that more patients will present from the general population and, accordingly, more patients with diabetes will experience…… [Read More]
Implementation of Strategies to educe Psychiatric eadmission
To this end, it is clear that hospital readmission remains a prevalent phenomenon in adult psychiatric patients, placing a huge morbidity and economic burden on individuals, families, and healthcare organizations (Burton, 2012; Machado et al., 2012). Addressing psychiatric readmission, therefore, is an important priority for healthcare providers. Evidence demonstrates that psychiatric readmission is mainly caused by ineffective transition of care from the inpatient to the outpatient setting (Kalseth et al., 2016). In essence, reducing psychiatric readmission requires effective care transition interventions. The purpose of this EBP project is to reduce readmissions in an adult psychiatric hospital by 10% over a three-month period.
There are several models that provide guidelines for the implementation of practice change. In this case, however, given the nature of the clinical setting and resource availability, osswurm & Larrabee's (1999) is deemed an appropriate model. The…… [Read More]
Quality Improvement Project
Diabetes -- Chronic Condition Background
Type 1 and Type 2 Diabetes
isk factors for type 1 diabetes
isk factors for prediabetes and type 2 diabetes
isk factors for gestational diabetes
The ationale for Selection
The Target Population
It has been estimated that in New York there is roughly two million people, or over twelve percent of the population, that have diabetes; furthermore, of this population, over half a million people have the condition but are not aware that they have it (American Diabetes Association, N.d.). It is further estimated that nearly five and a half million people, or over a third of the population, have prediabetes. Diabetes and diabetes-associated cardiovascular diseases have become the leading cause of death in the region accounting for roughly two-thirds of the deaths and the rates of diabetes has lead this trend to be referred to as the…… [Read More]
Arnold Palmer Hospital
Managing Service, Processes and Supply Chains
Hospitals and Supply Chains - Overview
Hospital Supply Chains - Advancements
Standard Supply Chain
Vendor Managed Inventory
Automated Point of Use Systems
The Next Step in Supply Chain Evolution
Arnold Palmer Hospital Supply Chain
The Arnold Palmer Hospital is one of the country's leading hospitals for women and children. It is located in Orlando, Florida and is currently a part of a national purchasing group in which it utilizes to provide supply chain purchases. Even though being a part of the purchasing group has some cost advantages stemming from the collective bargaining power, there are also many disadvantages that are not entirely consistent with the organizations priorities. These disadvantages can be mitigated by equipping the hospital with more modern supply chain technology. Therefore, an investigation was conducted that identified the supply chain options available for the…… [Read More]
Healthcare Quality Indicators
ith the adoption of the Affordable Care Act, also now commonly referred to as Obamacare, the array of quality indicators used to assess healthcare facility performance has expanded. The addition of a number of quality indicators with direct connections to penalties and other punitive measures has created a great deal of pressure for hospitals and other healthcare facilities. Many of these quality indicators are designed to heighten accountability among hospitals and other acute healthcare treatment cites or systems. Among them, penalties for preventable readmissions has become an exceptionally prominent indicator of performance quality.
According to Brink (2013), the quality indicator of readmission rates has become an important issue for healthcare leaders and hospital administrators. Brink reports that roughly 12% of all Medicare patients will be readmitted to the hospital within the first 30 days of discharge for recurrent conditions that could be prevented…… [Read More]
Patient eduation an be desribed as a proess by whih majorly health professionals and other related stakeholders impart information to patients together with their aregivers so that there an be improvement of health status and also alter health behavior of patients. Those who may be involved in health eduation may inlude physiians, pharmaists, registered nurses, psyhologists, speial interest groups, and pharmaeutial ompanies. Health eduation an also be used as a tool by managed are plans in general preventative eduation and health promotion. Some of the important elements that are supposed to be onsidered when dealing with patient eduation are skill building and responsibility. It is neessary for patients to know why, when and how they are required to make their lifestyle hange. This proess of patient eduation is apable of reduing healthare osts.
Looking at studies pertaining ost ontainment, it shows that patient eduation results to…… [Read More]
If a hospital has a poor record of infections and patient falls, those patients who have a choice will avoid the hospital. So, as the hospitals begin recording and tracking the information, those that do not choose to improve lose patients (HQA 2011). Contrary wise, those hospitals that remain on the cutting edge of improving the quality of care for patients are hospitals that will be sought after by patients who have an option.
Another possible reason for the desire to improve conditions is for the sake of attracting better physicians. Many physicians are selective as to the hospitals they serve with. For instance, most Catholic physicians tend to only seek admission to Catholic hospitals.
It is possible that hospitals may seek reimbursement as a means of dealing with quality issues with patients. Currently, when a hospital makes a mistake the patient is still expected to pay the full amount…… [Read More]
Evidence-Based Practice Project: educing ate of Psychiatric eadmission
The purpose of the evidence-based practice project is to examine ways to eliminate psychiatric readmissions. More specifically, literature is reviewed to examine evidence supporting the effectiveness of care transition interventions in preventing re-hospitalization amongst adult patients with severe mental illness. In this chapter, the search process is first described. Next, the identified literature is summarized and synthesized, clearly evaluating the relevance of the literature to the specified PICOT question.
Literature for the review was searched in CINAHL, PubMed, EBSCO, ProQuest, and Google Scholar databases using the following phrases: psychiatric readmission, re-hospitalization, care transition interventions, transitional care interventions, and reducing readmission in adults with mental illness. Focus was particularly on literature published in English. From the first round of search, it was quite evident that not much scholarly attention has been given to the topic as the search returned less than…… [Read More]
Myocardial Infarction Minimizing Hospital Readmission
Phase 1: EBP for Effective Patient Care Transition
Donald, an acute myocardial infarction (MI) patient, has undergone angioplasty, a procedure in which a catheter is inserted into clogged arteries in a patient’s heart to widen them and improve blood flow. To supplement the angioplasty, Donald has had cardiac stents placed to prop the affected arteries open and reduce their risk of narrowing again. Studies have shown that several complications could result from angioplasty procedures and the insertion of stents as in Donald’s case. The most common complications include bleeding or vascular complications (6 percent of patients), acute renal failure (5 percent of patients), and stroke (0.3 percent of patients) (Dunlay et al., 2012). A study analyzing readmission rates among MI patients in Minnesota found that bleeding was the most common complication after angioplasty, affecting 6 percent of patients (Dunlay et al., 2012). The most common…… [Read More]
Lagoe, R.J., et. al. (13 Aug 1999) "Analyzing hospital readmissions using statewide discharge databases." Nursing Care Quarterly 13(6): 57-67.
Why did the authors select hospital readmissions as a way to evaluate the quality of care for these DRGs?
In contrast to simply measuring the patient's lengths of stay, the swiftness or slowness of patient discharge rates, lengths of patient occupancy, or patient mortality, measuring hospital readmissions rates were through to be an effective means of evaluating quality of care. The readmissions rate specifically measures treatment efficiency, namely that readmission often occurs when a condition that was not likely to have been treated during the patient's first stay of occupancy. In other words, length of stay by definition is affected by the patient's severity of illness -- the fact that a hospital might treat more children with broken legs (necessitating overnight stay) than chicken pox (not necessitating overnight stay) is not…… [Read More]
The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge…… [Read More]
On March 23, 2010 the Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama. Along with the Health Care Reconciliation Act of 2010, the PPACA became part of the overall Health Care Reform concept of 2010. The health care reform process was promoted as a way to completely transform the health care industry and ensure that all Americans received affordable health care. hile supporters praise the legislation as a revolutionary law which will benefit ordinary Americans, critics claim that the Obama Administration used the health care reform process as a means of gaining control over the entire health care system. In an attempt to compare and contrast the provisions of this new law, this essay will discuss several provisions of the new health care legislation and compare the benefits as well as the criticisms of them.
Section 5501 of the PPACA provides for…… [Read More]
Transitional Care of Older Adults Hospitalized with Heart Failure Experiment
Naylor, M.D., Brooten, D., Campbell, R.L., Maislan, G.,, McCauley, K.M. Schuartz, J. Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized Trial.
This article has an interesting approach to summarizing the experiment that was conducted. Instead of a formal abstract, the article instead summarizes the design and outline in several sections. These sections include objectives, design, setting, participants, intervention, measurements, results, and conclusions. The sections that are listed replace the standard format for an abstract that condenses the design and the findings into one formal section. Personally, I prefer the organization of this format better as it more clearly illustrates all of the factors in the research in a clear and easily identifiable format.
Analysis of the Introduction
The authors of this research do state the problem that they are researching in a clear and coherent manner. The…… [Read More]
EBP is to facilitate strategy to eradicate short cycle return to second readmission of psychiatric patients on hospital beds. Doing so will assist health care providers in addressing the issue of bed shortage. eduction of readmission rates allows more space to be available for other patients and helps to cut costs as well as bring about better conformity with governmental regulations.
The search process used in this literature review began with searching key words in online databases such as Cochran eview, CINAHL, and other nursing research journal databases. Google Scholar was used as the primary search engine, with filters set to permit results from these particular databases. Key words used included "reducing readmission rates," "readmission psych," "causes of readmission psych hospital," "psych hospital readmission," "reduction of psych readmission," and other combinations of key words identified by relevant articles found after conducting these searches. More than a thousand articles…… [Read More]
Healthcare Administration -- New York State Care Act
The New York State Care (Caregiver Advise, ecord and Enable) Act was implemented into law in April this year. The development and enactment of this law is geared toward having a positive effect on caregivers who assist patients and family members recover in the aftermath of hospital admission. The legislation ensures patients in healthcare facilities can assign a family caregiver and the facility provides the designated caregiver instruction and illustrations of medical tasks they are likely to offer their loved ones at home. However, the implementation of this initiative across hospitals such as Winthrop Hospital has been characterized by several challenges that could hinder its effectiveness if not addressed.
New York State Care Act and its Importance/Benefit
There are approximately 2.8 million New Yorkers who offer unpaid care to their loved ones at any given time as well as nearly 1.6 million…… [Read More]
home health care services in extending care delivery to the home setting is increasing in contemporary times. Home health care aims to shorten hospitalization and reduce the frequency of visits to the hospital for patients recuperating from a surgical operation or disease, or living with a chronic illness such as cancer, heart disease, and diabetes (Centres for Medicare and Medicaid Services [CMS], n.d.). It enables patients to have more independent living and a better quality of life. The author's organisation specialises in home health care. In conjunction with hospitals and physicians, the organisation delivers a wide range of individualised care services to patients at their own homes. Whereas the organisation has performed impressively in terms of patient satisfaction, there is still room for improvement. In cognizance of increased demand for home health care due to the underlying greater demand for healthcare in general, it is imperative for the organisation to…… [Read More]
Health Care Improvements
The health care industry is one that is much criticized in the United States. Many consumers look at this industry as one big giant industry that is only concerned about profitability, not about the health and safety of its customers. The health care industry must make many changes to change their image and provide better service to its customers. Medicare is a government health care insurance that covers 80% of the medical cost for individuals over the age of 65 years. Medicare currently has a bad reputation with its customers and with doctors. It is important for Medicare to change its reputation and build better relationship with customers and with doctors. By changing their image, Medicare will attract more doctors to become participants and this will be a better service for the customers. In this paper I will address some important steps that Medicare could take to…… [Read More]
Furthermore, one of the pillars of collaborative care that will need to be firmly established is the fostering of clear dialogue and a means for strong communication within the care management planning. For instance, there needs to be a clear decision and communication of all tests ordered and when the test results will be available. One of the most important aspects of this collaborative care will be the nursing interventions which can have significant impact on the patient's health and stabilization (Allen, 2010). In fact, strategic nursing care can even minimize readmission rates of Margaret and other patients with comparable conditions (Chen et al., 2012).
Prioritize the Nursing Care Needs of Margaret
The prioritization of nursing interventions is essential, and the way in which a nurse determines this priority is going to be something unique and distinct. "Trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in…… [Read More]
download Chamberlain Library) the articles uploaded, upload the articles required reading
This is for the "Telemonitoring…" article
The purpose of this research is to determine if it is advantageous to employ electronic home monitoring (EHM) for heart failure patients. Advantageous is determined by whether or not additional costs and hospital visits could be reduced with this technology, and if it could increase the length of time between hospital visits.
The research questions in this study were implicit and stated in the form of three hypotheses. The first questioned whether or not lower costs, emergency room and hospital visits could be achieved with EHM, the second was whether or not quality of life and caregiver mastery could improve while lowering rates of depressive symptoms, and the final one wondered whether or not, the combination of EHM, caregiver mastery and informal social support could decrease the risk of readmission to hospitals.
The…… [Read More]
Sanford, J., Townsend-Rocchicciolli, J., Horigan, A., & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research & Theory for Nursing Practice, 25(1), 55-70.
Describe the data collection procedure.
This was a QUALITATIVE grounded theory study. Unstructured open-ended interviews were conducted in private mutually agreed on locations. Interviewers took notes and interviews were audiotaped. Interviews lasted from 45 minutes to 2 hours
what did the authors say about the reliability and validity of their data collection and analysis?
The authors did not address this point. On the contrary, they point out how their study contributes to previous studies on the topic.
What demographic information was reported?
The caregiver had to be related to the patient with heart failure, provide one activity of daily living, and/or assist the care recipient with two instrumental activities of daily living and not be paid for services. Demographic…… [Read More]
EClinicaWorks at ikers Island
ikers Island is a correctional facility that currently utilizes eClinicalWorks, which has emerged as a leader in medical software solutions. This paper examines the use of this electronic health records software at this correctional facility in relation to hospitalized inmates. The author includes an overview of how this software is run by Corizon Health and how the correctional facility works with Bellevue Hospital, which also has eClinicalWorks. The discussion includes an evaluation of how this software has been characterized by a workflow challenge that hinders effective workflows. The use of paper documentation by hospital staff because of inability of this software to visualize findings, discharge instructions or recommendations is discussed. This is followed by discussion of a proposed innovation and how it can be implemented using a project management approach. The final sections discuss strategies for going live and ongoing maintenance of the proposed innovation.
eClinicalWorks…… [Read More]
Planned change in the eldercare advocacy organization
In the coming years, many countries will experience a dramatic shift in healthcare infrastructure due to an expanding elderly population size. However, the changes may vary across countries depending on many factors such as the kind of social welfare available in each country, the political environment which determine policies, the level of healthcare available and individual expectations in each country. Due to this wide variance, the innovations within this space will also vary greatly. What this means to the healthcare manager is that managing innovations becomes very hard (Shlutz, Andre & Sjovold, 2015 p 42). This also impacts on performance management which is fast gaining popularity in the public sector as a means to improve on accountability. Unfortunately, it has been cumbered by a series of challenges in its implementation; this is in spite of the frameworks developed over the last couple of…… [Read More]
auspices and with a variety of purposes; this particular study described its secondary purpose as a method for describing decision making and the decision making process undertaken by patients with Heart Failure (HF). Even more importantly for this study was that the study's primary purpose was to determine and describe the process exhibited by the HF patient(s) care givers.
The specific question the study sought to answer was "How do caregivers of family members with HF make decisions" (p. 56).
The study was conducted using a "qualitative design" (p. 58). A qualitative design is normally conducted to gather data on perceptions, thoughts and beliefs concerning any number of subjects. This study was set up to determine the process of making decisions (regarding HF patients) by caregivers and why they made the decisions that they made. Since perceptions, beliefs and thoughts all play a significant role in medical treatment(s), the design…… [Read More]
Discharge Education to Promote Patient Self-Efficacy
Care and concern for the patient's health and well-being after being discharged from the hospital or clinic does not end for healthcare providers. Particularly for chronically ill patients, post-discharge care is more critical to ensure that in the course of the patient's daily routine and activities, all medical requirements are adhered to and all medications needed are complied with. This is why more often than not, patients receive discharge education as the healthcare provider's continuing effort to ensure that the patient and his/her family members or caregivers will be well-capacitated to continue care and treatment at home.
However, the above-mentioned scenario is the ideal rather than the actual. In real life, healthcare providers are often fraught with the dilemma of patients who are constantly hospitalized or have witnessed the worsening of their patient's condition as a result of non-compliance to their medications and other…… [Read More]
Healthcare Data Compare Healthcare Grade of Maryland to Florida
Healthcare grades: The Commonwealth Fund
The Commonwealth Fund grades all states on access to healthcare, avoidable hospital use and costs, healthy lives, and prevention and treatment. For example, Pennsylvania ranks 12 on access: nearly
percent of nonelderly adult patients are insured and 92% of children. Florida has around 74% and Maryland around 83% of adults insured and 82 and 91% of children, approximately. In Pennsylvania, 86% of at-risk adults have had a checkup within two years versus 87 and 88% in Florida and Maryland respectively; 90% of patients in PA have not had to forego seeing a physician within the last two years because of cost versus 84% in Florida and 89% in Maryland (approximately). The low rates of insurance coverage in Florida reflect higher unemployment and poverty rates, combined with a higher percentage of workers who labor part-time and do…… [Read More]
Aging and Social Policy
rends in Aging Social Policy
he Rise of the Contenders
he number of citizens above the age of 65 has expanded dramatically over the past 100 years. In 1900, the average life expectancy was just 47.3 years, but a child born in 2008 can expect to live another 30.8 years on average. From an economic perspective, the seniors alive 100 years ago were largely dependent on others for their survival and this realization triggered policy changes that provided many advantages, including a security net for retirees.
After World War II, the economy became robust enough that the aged began to experience a longer life expectancy and greater economic wealth. his resulted in the emergence of a politically powerful demographic that could begin to influence public policy on its own. his process has been viewed as cyclical, in that public policies strengthened a specific demographic and the…… [Read More]
Does taking Metoprolol before cardiac surgery reduce the incidence of post-op atrial fibrillation
Postoperative atrial fibrillation (POAF) remains a prevalent supraventricular arrhythmia. PoAF has associated effects such as deteriorating hemodynamic, increased risk of stroke and increased probability of death. Beta-blockers have been recommended as effective intervention mechanism of preventing PoAF. Metoprolol is one such beta-blocker that is commonly administered to prevent the incidence of PoAF. The systematic review below entails an analysis of six clinical trials that explore the effectiveness of metoprolol. The analysis identifies reduced hospitalization length, reduced mortality and reduced financial burden as the beneficial impact associated with the administration of prophylactic. The small number of studies reviewed limits the validity of the conclusion warranting future large sample size research.
Annually, approximately 750,000 cardiac surgery are performed globally with postoperative atrial fibrillation (PoAF) being the prevalent complications (George, et al., 2018). With the increasing proportion of elderly population…… [Read More]
Standards of Evaluation
Module 2- Standards of Evaluation
The overall care offered under my current Aenta health insurance plan appears to be excellent with regards to freedom of care and flexibility. The plan is a group plan meaning that it is though an employer and therefor the rates and copay is lower and subsidized by the employer. As with any plan, there are pros and cons regarding the overall coverage.
With regard to access, my Aetna plan is by far superior to other plans. My plan is a PPO. This means that I never have to ask for approval before seeing any physician or seeking treatment. Whereas with HMO plans, participants have an assigned primary care physician and they must seek approval in advance before seeing any specialists. So, my choices are unlimited with regard to physicians.
The only area where access is in question is regarding alternative healthcare services…… [Read More]
EMS Bill is primarily designed to modernize and transform the current Emergency Medical Services System. One of the cornerstones of the bill is improved integration of services, to provide better coordination of service delivery. Currently, the EMS system is fragmented with several disparate federal, state, and local entities participating in EMS service. esulting tensions and miscommunications are not only costly, but can also create medical errors. However, the proposed Field EMS Bill is far from perfect, and has far from universal support. One of the main EMS stakeholders, the International Association of Fire Chiefs (IAFC) has expressed concern about the way the bill is currently worded. In short, the Field EMS Bill is worded in ambiguous language that promotes core concepts like "value" over ethics and quality of care. Cost reduction seems to be a primary focus on the Field EMS Bill, rather than ensuring that first responders have access…… [Read More]
Hospital Admission Analysis
Readmission Statistics (Denominator)
Total Number of Readmits
Total Number of Patients Readmitted
# of Patients with Multiple Readmits
In looking at readmissions, there were only three patients that were re-admitted more than once. Everyone else admitted once and, at most, readmitted once. For the readmits, no single hospital seems to have a problem. One sidenote is that one of the readmits (patient 740019266) was readmitted once to Crouse and then twice more to St. Joseph's. The reason for each readmit for that same patient is actually different. Further, the overall reason for readmits varies greatly and is not defined by any primary or common causes except perhaps breathing/pain issues of many kinds.
Overall Admission Statistics
Admissions of Males (Total)
Admission of Females (Total)
Readmissions of Females
Readmissions of Males
Multiple Admissions - Males
Multiple Admissions - Females
In looking at the rates of admissions, readmissions and multiple…… [Read More]
Future of Healthcare as it Relates to the Geriatric Population
Description and Problem Statement
The geriatric population in the United States is growing and compared to the population of health care providers the geriatric population growth is advancing much more rapidly. This presents a problem in making provision of health care to the future geriatric population. While there is a growth in the demand for geriatric health care services, there is not a matching growth in the population of health care providers and in fact, a shortage presently exists.
The population of geriatric patients is experiencing rapid growth while the population of health care providers specifically trained in geriatric medicine is seriously lagging behind. In fact, of the approximately 650,000 medical doctors who are practicing, only a small percentage receives the training and education required to provide geriatric care. Exacerbating the problem is the fact that only three medical schools…… [Read More]
Of the new consults 23 were transferred to ICU and 43 remained on the wards. The transfer of these patients was greatly facilitated and the inpatient ward staff was greatly satisfied with the interaction with the Outreach Team. edside education, expert resources and better patient-family communication were the most valued features of the team when the in-patient ward staff was surveyed. We noted a tremendous increase in the accessibility of the ICU to the hospital population. We did not, however, notice a decrease in the number of cardiac arrests in the hospital." (Simone, et al., 2007)
It was reported in the work entitled: "Pilot Project at TGH Shows that Critical Care Response Teams Can Significantly Reduce Cardiac and Respiratory Arrests and Hospital Deaths" in 2007 that data gathered between May 2005 and May 2006 "on the impact of the critical care response teams on 342 patients in Toronto General Hospital,…… [Read More]
Sigma methodology to help lower patient length of stay while simultaneously improving financial and patient health outcomes. This paper first discusses the theoretical basis for this, outlining the Six Sigma methodology. Its history in health care and its use specifically to lower patient length of stay are both covered in the literature review section. The next section looks at the different measures that should be used to guide the Six Sigma process. Measurement is essential to Six Sigma, so it is critical that measures used are relevant to the problem at hand, and that the organization has means by which to measure the variables in question. A number of variables are proposed, and where there are challenges with their measurement some solutions are also offered.
One of the challenges for hospital administrators is to improve both the efficiency of their facilities while simultaneously improving patient outcomes. There are certainly…… [Read More]
he most common progressive chronic lung situations that would require the rehabilitation include interstitial lung disease, chest wall disease, bronchiectasis, and pre and post thoracic surgery. he fourth category of patients to offered pulmonary rehabilitation is those with recent exacerbation of COPD requiring hospitalization, without the anticipated recovery path, and whose functional baseline has changed significantly ("Service Specification," 2012).
Chronic lung diseases have developed to become one of the most common respiratory illnesses across the country. As the diseases have become one of the major reasons for hospitalizations of patients, they usually affect individuals at the age of 35 years and above despite of the fact that these individuals are usually not diagnosed until they are 50 years and above. he growth and rapid increase of chronic diseases is attributed to the tendency of many people with the disease not to get medical assistance. While the conditions continue…… [Read More]
(Shactman; Altman, 2002)
4. ecommendations for Overcoming these Barriers:
Some of the suggestions for overcoming these barriers are (i) appointment of a General Practitioner -- GP officers to work as a Liaison Officer between the ED and the community so that the communication is streamlined as well as processes of referral and feedback and development of clinical pathways. (ii) Expansion of community off-peak facilities, including the setting up of the capacity for community access to X-rays, Scanning, ultrasound, blood tests and observation beds. (iii) Initiation of a project to deal with frequent attenders to the ED through the development of management plans contributed to by the patient, their GP, the ED as also their specialist (iv) Education of the local community such that are aware as to when and under what situations to access ED care or alternative care in the community. (Ardagh; ichardson, 2004)
Ardagh, Michael; ichardson, Sandra.…… [Read More]
Shuttling the results from an outside provider, because the health insurance agency will only reimburse outside screening, forces the patient to wait and possibly incurs more costs, if the delays in obtaining diagnostic information worsen the patient's condition. This can ultimately result in more prolonged treatment. Many patients may also be put at risk because of the logistics of being transported to outpatient facilities for essential screening and rehabilitative services, while they are still convalescing.
Being able to conduct all necessary tests in-house results in great efficiency, swifter screening, and improves coordination between the different providers involved in the case. Our hospital has extensive resources for patients, and can provide a wide range of treatment options, particularly in its specializations of cardiac and orthopedic care. And improvements in technology that are keeping extremely sick patients alive for longer periods of time also mean that, quite often, patients require attention from…… [Read More]
TOTAL EQUITY AND LIABIULITIES
(2) Discussion topic: Technology and Tools
Lower start-up costs. Fewer issues with maintenance of hardware. More resources including personnel and sophisticated procedures for security and backup of the patient information.
More ongoing expense over the long-term.
Subject to interruptions to the Internet, which restricts access to the EM data.
The clinical information may be stored along with data from other practices.
Enhanced patient safety with respect to drug allergies or interactions and proper dosage. Enhanced documentation with access to digital imaging and special testing. Better integration between the clinic and the business department.
Although somewhat remote, a vendor providing web-based EM…… [Read More]
Discharge Education to Promote Self-Efficacy in Heart Failure
An Education Intervention For Patients With Heart Failure
Management of congestive heart failure (CHF) continues to be a financial burden on the economy of the United States of America (USA); responsible for multiple hospital admissions and readmissions of patients with HF within thirty days post discharge. The disease has been associated with personal, physical, and economic challenges. As the population increases, the number of individuals affected with this condition is also increasing. According to the American Heart Association (2009), an estimated 400,000 to 500.000 new cases occur annually, with additional annual cost of more than $33 billion dollars added to the U.S. economy.
Discharge education, which attempts to reduce readmission rate, has become a valuable metric in the provision of health care. For effective management of heart failure symptoms, patient education is a necessity (Gruszczynski, 2010). Sara Paul (2008) discussed the importance…… [Read More]
evidence- based practice project is to compare the effects of bedside handoff report to handoff report away from the bedside using the IOWA model of evidence-based practice. The efficacy of the bedside handoff shall be determined by the variations in the patient contentment scores on personnel responsiveness and nurse communication. The project shall actually be applied in a sub-acute unit having grownup post-operative patients. Presently in the facility, handover is conducted at the conference room with the nurses and not including involvement of the patients. In accordance to the TUTHPOINT survey, patients have been lamenting regarding the absence of nursing personnel on the unit to actually assist them during the report time that resulted to a drop in the satisfaction of the patients. In addition, the survey also stated that numerous patients felt as if there existed no communication between them and the nurses, and they were not taking part…… [Read More]
ENEFITS, ARRIERS, CHALLENGES
ackground and Origin
Progressive mobility refers to a series of planned and sequential movements aimed at bringing the patient back to his or her baseline (Vollman, 2010). It consists of positioning and mobility techniques. A meta-analysis of 39 randomized trials was conducted to examine the effect of bed rest on 15 different medical conditions and procedures. Four short-term medical conditions were identified for critically ill patients. ut the major and long-term complication was the reduced quality of life after discharge on account of lost physical functions during their stay at the ICU. Another study conducted among survivors of acute respiratory conditions found that they lost 18% of their body weight and suffered much functional limitations from muscle wasting and fatigue. The more than 5 million who get confined at the ICU must come to terms with both the short- and long-term complications of immobility or prolonged…… [Read More]
Healthcare Database for esearch and Analysis
South Carolina is amongst states that take part in the Health Cost and Utilization Program (HCUP). Sandra Kelly, the person to contact regarding all matters pertaining to the program is the Operations Manager in the Demographics and Health department. The evenue and Fiscal Affairs of South Carolina under which it operates is situated on 1919, Blanding Street in Colombia, SC 29201. (803) *** is her phone number and (803) *** her fax number. One can also contact her online through Sandra.- --, her official email-id. The data from South Carolina entails stays by inpatients from hospitals offering care for acute health. The data recorded from the hospitals does not cover a whole calendar year as some experience technical defects (SID File Composition - South Carolina, n.d.), while others close at some point in the year.
The HCUP is the state's main source of gathering…… [Read More]
Performance scorecards provide a straightforward means of integrating metrics into a healthcare organization’s strategic planning. Scorecards are most effective when they have a clear purpose, identifying specific patient populations and outcome measures. According to Baker (2015), “savvy organizations select the best metrics to track that are appropriate to what the organizational staff members wish to measure,” which could include specific issues like patient vital signs or patient satisfaction survey outcomes (p. 224). Moreover, performance scorecards need to be simple, kept on a manageable scale so that the data gleaned can be readily communicated to inform organizational practices, policies, and procedures (Hansel, n.d.). The following performance scorecard includes three core categories including performance, quality, patient safety, and employee engagement, all while focusing on addressing the needs of a specific patient population: adults over the age of 65 who have been diagnosed with Type II Diabetes.
REVIEW…… [Read More]
Naylor, PhD,, Dorothy A. Brooten, PhD, oberta L. Campbell, PhD, Greg Maislin, MS, MA, Kathleen M. McCauley, PhD, and J. Sanford Schwartz, MD. All of the authors have graduate or post graduate degrees in the fields of health or medicine. This therefore makes them all qualified to write on the proposed study, and to carry out the research. They are, therefore, reliable and credible researchers in this field.
The title of the article itself; is appropriate to the title of the article; "Transitional Care of Older Adults Hospitalized with Heart Failure: A andomized, Controlled Trial." Since the study focuses on the transition of older adults with heart failure, and the title of the article is represented, the title of the article is appropriate to the title of the study.
The abstract discusses how recent research suggests older adults with heart conditions, facing therapeutic regimes, are often stressed out and vulnerable…… [Read More]
Affordable Care Act & Nursing
There are a number of different provisions of the Affordable Care Act that were designed to improve the health care system -- well, all of the provisions were designed to do that. The most immediate improvements will be the provisions that low the cost of drugs (such as the Medicaid rebate for brand name drugs) and the generics approval change. The biggest change that affects the quality of care is probably the provision regarding readmissions. The core of this provision is the idea that high rates of readmissions indicates a relatively poor standard of care is being given; so penalties for high readmission rates will encourage hospitals to have a higher standard of care in the first place, doing more for underlying conditions instead of just treating symptoms. Another beneficial provision is that plans now need to cover several types of preventative screening.
There are…… [Read More]
health care to the elderly.
In the next several years, many commentators argue that population aging will considerably affect the federal budget. When one turns sixty-five, his or her cost of care doesn't abruptly increase. However, the cost of healthcare to the federal government will go up since at that age Medicare usually becomes the main or primary insurer. According to studies by the CBO (Congressional Budget Office), over the next two decades, population aging will account for over fifty percent spending growth on various government healthcare programs (What Is Driving U.S. Health Care Spending? America's Unsustainable Health Care Cost Growth). As the baby boomers age, the population will lead to a higher percentage of seniors, which will in turn lead to an overall increase in per capita spending. Studies indicate that over the next decade or so, the aging American population will contribute to the increase in healthcare spending…… [Read More]
Since modern medicine can sustain patients with proper medical follow-up for years, it becomes incumbent on the profession to follow the patients and provide them with the knowledge and tracking to insure that they are observing the procedures and medications which prolong their quality of life. Given hospitals' short-term orientation with the patients, there is a need to bridge patient care before, during and after acute-care visits.
While there are some nursing specialties which can be regarded as solely hospital- or community-based, many of the specialties call for a more holistic notion of patient care. y combining the CNS and NP specialties, this profession has a better chance of assuring better patient outcomes, and a better quality of life for the patient.
ennett, .J. (1998). Psychiatric mental health nursing: thriving in a changing environment through outcomes-based measurements. Semin. Nurse Manage., 144-148.
erger, a.M.-F. (1996). Advanced practice roles for nurses…… [Read More]
Stroke is identified as one of the leading causes of death and to decrease mortality rate a review of the causes is required. The importance of measuring and reviewing health care quality is no longer questioned. However quantifying quality is a difficult task one that involves a subjective element and judgment. Different methods are employed in measuring quality such as level of care provided, administration accuracy, staff sufficiency, hygiene level and therapies provided. The need to combine the facts and figures with judgments and evaluation is a complex process and needs to be done with utmost care. The quality measures need to be evaluated on a regular basis to ensure their relevance and validity in the given circumstances.
Measures used to monitor and review quality:
As the hospital administration began to realize the link between stroke patients death and the quality of service rendered the need to analyze data…… [Read More]
business plan provides a process change for bedside patient handoffs at Samaritan Medical Center, Watertown, New York. An overview of the medical center is followed by its mission and vision statements, and organizational values. A discussion of the assumptions involved together with a breakdown of associated costs involved in the business plan are followed by a discussion of the importance of timely patient handoffs and a description of the proposed bedside handoff protocols for Samaritan Medical Center.
Overview of Samaritan Medical Center:
"Samaritan Medical Center (Watertown, New York) is a 294-bed not-for-profit community medical center, offering a full spectrum of inpatient and outpatient healthcare services. From primary and emergency care to highly specialized medical and surgical services, such as cancer treatment, neonatal intensive care, behavioural health and addiction services, and imaging services, Samaritan Medical Centre and its team of healthcare professionals proudly serves the medical needs of our civilian and…… [Read More]
Ineffective Communication Between Shifts in Acute Care Settings
A recent statistics of the adverse effects arisen from ineffective communication between shifts in acute care setting range from 2.6% to 7.6%, however, Okoniewska, et al. (2015) believes that the adverse effects on in-patients can be between 19% and 23%. (Classen, esar, Griffin. et al. 2011).
The Study aims to discuss the adverse effective arisen from ineffective communication between shifts within acute care settings.
Consequences of not solving the problem
Without implementing the strategies that can enhance effective communication between shifts in an acute healthcare setting, the issue can lead to mortality, readmission, and post-hospital adverse effects. Moreover, poor communication between shifts can lead to medication problems resulting to therapeutic errors. (Okoniewska, et al. 2015). Moreover, lack of intervention to address the problem can lead to medical errors, which can lead to patients' harms. Communication failure has also been identified as…… [Read More]
With the ever-changing health care sector, reimbursement has increasingly been tied to care quality and health care outcomes. The Centers for Medicare and Medicaid Services (CMS) have particularly been changing the way hospitals are reimbursed, with hospitals that deliver high quality care and report better health outcomes getting higher reimbursements than those that perform poorly. This has led to increasing prominence of the pay-for-performance approach. Under this approach, hospitals that report greater patient satisfaction, reduced error rates, lower readmission rates, and higher recovery rates for chronic illness get higher reimbursements than their poorly-performing counterparts. The implication is that health care organizations must pay greater attention to performance, especially in terms of quality, safety, and individual performance. Measurement and models used in the commercial world for these three aspects are considerably relevant to the health care sector. This paper discusses the usefulness of the total quality management (TQM) model, the Organization…… [Read More]
EH Assessment and Evaluation to Support Healthcare Outcome Objectives
The outcome-related goals that the tertiary care hospital seeks to achieve include the following: 1) Strengthen adult admissions screening at intake for pain, depression, and adverse health behaviors such as smoking, excess alcohol intake, and body mass index (BMI) greater than 30; 2) implement comprehensive geriatric assessment for all adults 65 years of age and over who are hospitalized for more than seven days or readmitted within less than three days following discharge; and 3) promote care team performance. The electronic health record (EH) is the default system for adult admissions, and it includes documentation standards and structures such as SOAP and checklists. Hospital staff are provided periodic guidelines through educational venues or through referral to the electronic policy and procedure manual. Given this information, the data elements that should be included in the EH assessment and evaluation screens are as…… [Read More]
G1d, and G1g Planned Intervention
Description of Intervention:
Medication adherence is one of the effective interventions for diabetes management. Adherence to medication is the extent patients take medications being prescribed for them by health care providers. In other words, a medication adherence refers to the extent patients have conformed to providers recommendations with regards to dosages, timing as well as frequency of medication taking by patients. aising educational awareness about the importance of adherence to medication is very critical to reduce the rate of readmission. If there is an increase in the level of awareness among patients and educating them about how medications are very important for the management of diabetes, the rate of medication adherence will increase among patients.
The best intervention strategy for the medication adherence is to use SIMPLE model for patients. The SIMPLE model consists of:
S -- Simplify the medication regime
I -- Impart…… [Read More]
Responsibilities of Nurses to Patients
Why is it important
The role of nurses has a direct implication on the patients. For example, nurses observe and provide direct care to the patients. The physicians give orders and thus are the role of the nurses to implement (Aiken et al., 2014). Often, the work of the physicians is not complete without the help of the nurses. The nurses are responsible for changing clothes and giving the medications to patients. Often, the patients are unable to do basic tasks, and therefore the roles of nurses become very important. Nurses keep medical records for the patients and therefore give medications to the patients in time and monitor their progress.
Another important role of the nurse is assessing the response of the patients to medications. Keep the records for the progress of patients is an invaluable practice. The records help the nurses to monitor how…… [Read More]
The audience is realized to find that he has been dreaming, but the dread remains for both he father and the son. Early on in genetics was given some effect in diagnosis of schizophrenia:
In a classic 1966 paper, Leonard Heston compared foster children who were separated at birth from their schizophrenic biological mothers and foster children who were separated at birth from their psychologically healthy biological mothers. Schizophrenia appeared only in a subset (about 16%) of the children whose biological mothers had schizophrenia, a finding which suggested that rather than bad parenting, genetics plays a powerful although only partial role in the emergence of schizophrenia. (Parens, 2004)
But there are also environmental factors cited as well.
The way we perceive the world is created in large part by our nurturing environment. Highly critical parenting is one of the factors cited in those with schizophrenia as well as more serious…… [Read More]
Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily chores and quality of life (Alaloul, Williams, Myers, Jones, & Logdson, 2015). While health care expenses have increased significantly over the years, there have been great improvements in increasing both family and patient involvement in medical care. Hourly care is one of the strategies that have worked well in various healthcare settings. Hourly care has been a success in various areas but using it in urgent pediatric settings hasn't been well documented (Emerson, Chumra, & Walker, 2013). Opportunities still exist to look into pediatric family preferences and perspectives as pertains to the use of whiteboards (Cholli, et al., 2016). Several studies have been done in different setups and this paper references many of them. The research projects include in-patient surveys, quasi-experimental…… [Read More]
cute care facilities try to maintain low costs and employ quality nurses. Within this statement is a double standard. How can we have quality nurses and cut costs at the same time? This is where the skill mix comes into play. In the skill mix, there are Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and unlicensed staff. If the lesser skilled staff free RNs they can be better able to perform their nursing duties and assessments. If acute care facilities can agree on an appropriate number of each type of staff member within the facility, they might be better able to accomplish safe patient outcomes while keeping costs down.
Determining nurse-to-patient ratios is a complex issue where one solution is not sufficient to cover all circumstances. The merican Nurses ssociation assembled a panel of nursing and health professionals to research appropriate staffing levels. The panel developed the following Matrix for…… [Read More]