Effect of INTERACT on Promoting Nursing Staff’s Self-Efficacy Leading to a Reduction of Rehospitalizations from Short-Stay Care

One in four clients discharged from an acute care facility to a skilled nursing facility (SNF) required readmission to the hospital within 30 days. Neuman, Wirtalla & Werner believe that two-third of those readmissions are avoidable. Reducing the frequency of rehospitalization from short-stay care is essential for two primary reasons: 1) Clients are exposed to hospital-acquired infections that lead to increased comorbidities, and 2) potentially avoidable hospitalization will decrease the amount of funding distributed by Medicare. The setting for the proposed change initiative was a for-profit, nondenominational SNF in Missouri. Of the 120 beds, 16 were devoted to short-stay care. The convenience sample included four registered nurses and eight licensed practical nurses who had agreed to participate in the pilot. The purposive sample included short-stay clients. Interventions implemented at the pilot skilled nursing facility are components of the validated INTERACT quality improvement program. INTERACT (Appendix A) is comprised of several tools designed to assist and guide front-line staff in early identification, assessment, communication, and documentation about acute changes in client condition. Measured results examined the effectiveness of the proposed intervention. The outcome being assessed in the project was the number of avoidable hospital admissions after implementation of the INTERACT quality initiative tools. The long-term objective for the pilot was a 2% decrease in client rehospitalizations from the short-care unit during the eight weeks of practice implementation. The clinical question for the proposed practicum project was, “For the nursing staff on a short-term rehab unit, does the implementation of an evidence-based patient evaluation tool, INTERACT lead to a reduction in avoidable hospital admissions?”.

Effect of mother’s knowledge on posteducation toward rehospitalization of young children with pneumonia

Objective:The rehospitalization rate of children<5 years old with pneumonia is still high.The risk of hospitalization becomes higher in mothers with low knowledge of their child’s disease.The purpose of this study was to determine the effect of post-health-education maternal knowledge in cases of rehospitalization and to determine the differences in rehospitalization rate based on the type of health education media.Methods:This study is a quasi-experiment.Health education was given to both groups:one group received education through audiovisual media and the other group through leaflet media.The level of post-health-education knowledge was measured on the third day,then followed up until the 30th day after the patient was discharged from the hospital.Results:Post-health-education knowledge significantly reduced the cases of rehospitalization in both groups.However,the rehospitalization rate in the audiovisual group was lower than in the leaflet group(P=0.047,odds ratio=5.870).Conclusions:Post-health-education knowledge is effective in reducing the risk of rehospitalization,and health education using audiovisual media is more effective,compared to health education using leaflets,in reducing the cases of rehospitalization in children<5 years of age with pneumonia.

Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol

BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after surgery(ERAS)protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications.AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022.Among them,99 patients were managed using the traditional perioperative care approach(non-ERAS protocol),while the remaining 99 patients were managed using the ERAS protocol.Relevant indicator data were collected for patients preoperatively,intraoperatively,and postoperatively,and surgical outcomes were compared between the two groups.RESULTS The comparison results between the two groups of patients in terms of age,sex,BMI,underlying diseases,surgical type,and preoperative hospital stay showed no statistically significant differences.However,the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group(4.0±0.9 h vs 7.6±0.9 h).Regarding intraoperative indicators,there were no significant differences between the two groups of patients.However,in terms of postoperative recovery,the ERAS protocol group exhibited significant advantages over the non-ERAS group,including a shorter hospital stay,lower postoperative pain scores and postoperative hunger scores,and higher satisfaction levels.The readmission rate was lower in the ERAS protocol group than in the non-ERAS group(3.0%vs 8.1%),although the difference was not significant.Furthermore,there were significant differences between the two groups in terms of postoperative nausea and vomiting severity,postoperative abdominal distention at 24 h,and daily life ability scores.CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy,including reduced readmission rates,decreased postoperative nausea and vomiting,alleviated abdominal distension,and enhanced functional capacity.While the protocol may not exhibit significant improvement in early postoperative symptoms,it does exhibit advantages in long-term postoperative symptoms and recovery.These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients,as it contributes to improving patients'recovery and quality of life while reducing health care resource utilization.

Predictors of re-hospitalization in patients with chronic heart failure

Heart failure (HF) is a chronic, progressive illness that is highly prevalent in the United States and worldwide. This morbid illness carries a very poor prognosis, and leads to frequent hospitalizations. Repeat hospitalization in HF is both largely burdensome to the patient and the healthcare system, as it is one of the most costly medical diagnoses among Medicare recipients. For years, investigators have strived to determine methods to reduce hospitalization rates of HF patients. Despite such efforts, recent reports indicate that rehospitalization rates remain persistently high, without any improvement over the past several years and thus, this topic clearly needs aggressive attention. We performed a key-word search of the literature for relevant citations. Published articles, limited to English abstracts indexed primarily in the PubMed database through the year 2011, were reviewed. This article discusses various clinical parameters, serum biomarkers, hemodynamic parameters, and psychosocial factors that have been reviewed in the literature as predictors of re-hospitalization of HF patients. With this information, ourhope is that the future holds better risk-stratification models that will allow providers to identify high-risk patients, and better customize effective interventions according to the needs of each individual HF patient.

Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

Background:This study aimed to assess the prescribing patterns of evidencebased pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction(HFrEF)in Thailand.Methods:A retrospective cohort study of patients with HFrEF was conducted.Treatment with aβ-blocker and renin-angiotensin system inhibitors(RASIs)with or without mineralocorticoid receptor antagonists(MRAs)at discharge was regarded as guideline-directed medical therapy(GDMT).All others were considered non-GDMT.The primary endpoint was the composite of all-cause mortality or heart failure(HF)rehospitalization.Inverse-probabilitytreatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects.Results:In total,653 patients with HFrEF(mean age 64.1±14.3 years;55.9%male)were included.GDMT withβ-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%.During a median of 1-year follow-up,167 patients(27.5%)had a composite event,81 patients(13.3%)had all-cause mortality,and 109 patients(18.0%)had HF rehospitalization.Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint(adjusted hazard ratio[HR]0.63;95%CI 0.44-0.89;p=0.009)compared with patients who did not receive GDMT.The use of GDMT was also associated with a significantly lower risk of all-cause mortality(adjusted HR 0.59;95%CI 0.36-0.98;p=0.045)and HF rehospitalization(adjusted HR 0.65;95%CI 0.43-0.96;p=0.031).Conclusions:For HFrEF treatment,GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization.Nevertheless,prescribing GDMT remains underused,and it could be encouraged to improve HF outcomes in real-world settings.