Congestive Heart Failure and Re-admissions Prevention

Literature Review-Congestive Heart Failure and Re-admissions Prevention Essay Assignment Paper

PICOT Question: Among Medicare patients discharged with a diagnosis of CHF (P) how does discharge planning (I) compared to follow-up via telephone calls(C) prevent readmission within 30days (O) post discharge?

Search History

Search Methods

An initial search was conducted using the search engine of EBSCOHost in CINAHL, PubMed, Cochrane and Medline databases for full-text articles on the topic of study. The search used keywords such as preventing readmissions, heart failure, discharge planning, and telephone calls. This literature search was limited to English articles that had been published within the past 10 years.

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Search Results Summary

According to the overall search which yielded a total of 20 articles based on the research topic, a further review was done which contributed to the narrowing of these search findings to 10 articles. After applying the exclusion criterion where: articles which were published before the year 2010, articles in other languages other than English and those which used a small sample populations were excluded, only 5 articles met the inclusion criterion. Therefore, all the articles included in the literature review talked about discharge planning to reduce readmissions 30 days post discharge in previously hospitalized heart failure patients and were published between the years 2010-2019.

Literature Review

A common finding on all the articles with regards to the background knowledge was that heart failure readmissions comprise the most significant economic burden. According to the American Heart Association, the overall direct costs for managing patients with heart failure the year 2014 was $21 billion and this amount was estimated to increase by the year 2040 to approximately $53 billion. Chamberlain et al., (2018) noted that heart failure affects more than 5 million Americans annually and accounts for more than 1 million hospital admissions, a finding that was also notable by Shan et al (2014) and Masri et al (2018). Congestive heart failure was also noted to be a leading cause of morbidities and mortalities which can be prevented through evidence-based practice.Literature Review-Congestive Heart Failure and Re-admissions Prevention Essay

It is for this reason that researchers, clinicians, and policymakers have prioritized it as a focus for reforms in healthcare. For instance, to address the gradually increasing number of hospital readmissions, and improve health outcomes and the quality of life among patients with heart failure, numerous nurse-led interventions have been instituted in the community, inpatient and primary care settings (Chamberlain et al., 2018). For the same reason, the Affordable Care Act saw the implementation of a hospital reductions program to make sure that the reimbursements made to hospitals with high risk-standard readmissions by the CMS were decreased. As noted by Ziaeian & Fonarow (2016), despite the numerous interventions which currently exist, high readmission rates continue to be experienced in inpatient care settings.

In an integrative review of literature which was conducted by Shan et al (2014), it was found that educating patients, giving them instructions on self-care at the time of discharge and effective follow-up contributed to optimal management of medical needs and was effective in reducing the readmission rates among heart failure patients after being discharged from hospital. A similar finding was made by Wan et al., (2017) and Ziaeian & Fonarow (2016) in systematic reviews which purposed to find the most effective interventions to lower the rates of readmission among patients with congestive heart failure. According to Ziaeian & Fonarow (2016), at the time of discharge, most patients are usually not aware of any alterations made to their medication which is an avenue for medication errors. Discharge planning provides nurses with the time and platform to increase the support they give patients, discuss medications prescribed with patients with the specific dosages and dietary modifications. In comparison, Wan et al., (2017) found that discharge planning provides nurses with the opportunity to write high quality and comprehensive discharge summaries which are linked to low readmission rates for patients with heart failure. Comprehensive discharge summaries help to prevent premature discharges through improved clinical decision making and promote the coordination of care between patients and healthcare providers.Literature Review-Congestive Heart Failure and Re-admissions Prevention Essay

Conclusion and Recommendations for Further Research

The high readmission rates among heart failure patients currently experienced in inpatient care settings call for the development of alternative evidence-based strategies that will influence significant reductions in medical costs, mortalities, morbidities and improved quality of care. Based on the literature review findings, it is evident that discharge planning can be helpful in attaining this target. Discharge planning involves: conducting periodic follow-up visits, providing social, emotional, physical and psychological support, patient nutrition and medication education. Before and after discharge, the needs of patients have to be addressed adequately by nurses. However, in order to achieve this, it is mandatory for nurses to have adequate knowledge of acute and chronic heart failure and the medical needs of patients with heart failure. Therefore, further research needs to assess nurses’ knowledge of acute and chronic heart failure, associated risk factors, pathophysiology, pharmacological and non-pharmacological management. It is only with this knowledge that nurses can be able to apply it in clinical practice and efficiently optimize the care given to heart failure patients during admission and after discharge.Literature Review-Congestive Heart Failure and Re-admissions Prevention Essay

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