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Bosch L, Zwetsloot PPM, Brons M, van Hout GPJ, van der Meer MG, Szymanski MK, Troost-Oppelaar AM, Ramjankhan FZ, van der Harst P, Gianoli M, Oerlemans MIFJ, van Laake LW. Healthcare consumption of patients with left ventricular assist device: real-world data. Neth Heart J 2024; 32:317-325. [PMID: 39141306 PMCID: PMC11336021 DOI: 10.1007/s12471-024-01885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND A left ventricular assist device (LVAD) is a life-saving but intensive therapy for patients with end-stage heart failure. We evaluated the healthcare consumption in a cohort of LVAD patients in our centre over 6 years. METHODS All patients with a primary LVAD implantation at the University Medical Centre Utrecht in Utrecht, the Netherlands from 2016 through 2021 were included in this analysis. Subsequent hospital stay, outpatient clinic visits, emergency department visits and readmissions were recorded. RESULTS During the investigated period, 226 LVADs were implanted, ranging from 32 in 2016 to 45 in 2020. Most LVADs were implanted in patients aged 40-60 years, while they were supported by or sliding on inotropes (Interagency Registry for Mechanically Assisted Circulatory Support class 2 or 3). Around the time of LVAD implantation, the median total hospital stay was 41 days. As the size of the LVAD cohort increased over time, the total annual number of outpatient clinic visits also increased, from 124 in 2016 to 812 in 2021 (p = 0.003). The numbers of emergency department visits and readmissions significantly increased in the 6‑year period as well, with a total number of 553 emergency department visits and 614 readmissions. Over the years, the annual number of outpatient clinic visits decreased by 1 per patient-year follow-up, while the annual numbers of emergency department visits and readmissions per patient-year remained stable. CONCLUSION The number of patients supported by an LVAD has grown steadily over the last years, requiring a more specialised healthcare in this particular population.
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Affiliation(s)
- Lena Bosch
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Maaike Brons
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gerardus P J van Hout
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Transplantation Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mariusz K Szymanski
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Transplantation Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Faiz Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marish I F J Oerlemans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Transplantation Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Linda W van Laake
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
- Transplantation Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Kyriakopoulos CP, Selzman CH, Giannouchos TV, Mylavarapu R, Sideris K, Elmer A, Vance N, Hanff TC, Kagawa H, Stehlik J, Drakos SG, Goodwin ML. Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices. J Clin Med 2024; 13:2869. [PMID: 38792411 PMCID: PMC11122328 DOI: 10.3390/jcm13102869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Centrifugal-flow left ventricular assist devices (CF-LVADs) have improved morbidity and mortality for their recipients. Hospital readmissions remain common, negatively impacting quality of life and survival. We sought to identify risk factors associated with hospital readmissions among patients with CF-LVADs. Methods: Consecutive patients receiving a CF-LVAD between February 2011 and March 2021 were retrospectively evaluated using prospectively maintained institutional databases. Hospital readmissions within three years post-LVAD implantation were dichotomized into heart failure (HF)/LVAD-related or non-HF/LVAD-related readmissions. Multivariable Cox regression models augmented using a machine learning algorithm, the least absolute shrinkage and selection operator (LASSO) method, for variable selection were used to estimate associations between HF/LVAD-related readmissions and pre-, intra- and post-operative clinical variables. Results: A total of 204 CF-LVAD recipients were included, of which 138 (67.7%) had at least one HF/LVAD-related readmission. HF/LVAD-related readmissions accounted for 74.4% (436/586) of total readmissions. The main reasons for HF/LVAD-related readmissions were major bleeding, major infection, HF exacerbation, and neurological dysfunction. Using pre-LVAD variables, HF/LVAD-related readmissions were associated with substance use, previous cardiac surgery, HF duration, pre-LVAD inotrope dependence, percutaneous LVAD/VA-ECMO support, LVAD type, and the left ventricular ejection fraction in multivariable analysis (Harrell's concordance c-statistic; 0.629). After adding intra- and post-operative variables in the multivariable model, LVAD implant hospitalization length of stay was an additional predictor of readmission. Conclusions: Using machine learning-based techniques, we generated models identifying pre-, intra-, and post-operative variables associated with a higher likelihood of rehospitalizations among patients on CF-LVAD support. These models could provide guidance in identifying patients with increased readmission risk for whom clinical strategies to mitigate this risk may further improve LVAD recipient outcomes.
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Affiliation(s)
- Christos P. Kyriakopoulos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Craig H. Selzman
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Theodoros V. Giannouchos
- Department of Health Policy & Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Rohan Mylavarapu
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Konstantinos Sideris
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
| | - Ashley Elmer
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Nathan Vance
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Thomas C. Hanff
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
| | - Hiroshi Kagawa
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
| | - Stavros G. Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (K.S.); (T.C.H.); (J.S.); (S.G.D.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Matthew L. Goodwin
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA; (C.H.S.); (R.M.); (A.E.); (N.V.); (H.K.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, UT 84132, USA
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Kato NP, Melnikov S, Denfeld QE, Casida J, Strömberg A, Ben-Gal T, Lee CS, Jaarsma T. Validity and reliability of the left ventricular assist device self-care behaviour scale. PLoS One 2023; 18:e0275465. [PMID: 36763631 PMCID: PMC9917258 DOI: 10.1371/journal.pone.0275465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/18/2022] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Adequate self-care behaviour is essential for patients with a left ventricular assist device (LVAD) to prevent complications, prolong life, and optimise quality of life. However, there were no valid and reliable measurements available to assess self-care behaviour among patients with LVAD. We have previously developed the 33-item LVAD self-care behaviour scale. OBJECTIVES To evaluate psychometric properties of the 33-item LVAD self-care behaviour scale. METHODS AND RESULTS Data on 127 patients with a LVAD in Israel, Japan, and the USA were analysed (mean age 51±14.3, 81% male). Exploratory factor analysis extracted three factors, and 13 items were excluded from the scale. Internal consistency assessed by Cronbach's alpha was acceptable for the total scale (α = 0.80) and the three subscales: Factor 1: Monitoring (α = 0.81), Factor 2: Heart failure self-care (α = 0.67), and Factor 3: LVAD self-care (α = 0.63). The 20-item version of the LVAD self-care behaviour scale had sufficient convergent validity with another scale that assessed self-care related to the driveline of LVAD (r = 0.47, p<0.001). Test-retest reliability was adequate (intraclass correlation coefficient = 0.58). CONCLUSIONS The 20-item version of the LVAD self-care behaviour scale showed adequate validity and reliability. The scale is ready for use in clinical practice and research. Additional testing might further optimise the scale.
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Affiliation(s)
- Naoko P. Kato
- Department of Health, Division of Nursing Sciences and Reproductive Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Hospital, Tokyo, Japan
- * E-mail:
| | - Semyon Melnikov
- Sackler Faculty of Medicine, Department of Nursing, Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Quin E. Denfeld
- School of Nursing & Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Jesus Casida
- Eleanor Mann School of Nursing, The University of Arkansas, Fayetteville, Arkansas, United States of America
| | - Anna Strömberg
- Department of Health, Division of Nursing Sciences and Reproductive Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tuvia Ben-Gal
- Sackler Faculty of Medicine, Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | - Christopher S. Lee
- The Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts, United States of America
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Tiny Jaarsma
- Department of Health, Division of Nursing Sciences and Reproductive Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lockard KL, Dunn E, Kunz N, Pearsol A, Schaub RD, Severyn DA, Lohmann D, McCall M, Morelli B, Teuteberg JJ, Kormos RL, Sciortino CM, Dew MA. Evaluation of a Health Care Performance Improvement Initiative to Facilitate Optimal Clinical Outcomes in Patients Receiving Ventricular Assist Device Support. Prog Transplant 2020; 30:376-381. [PMID: 32985349 DOI: 10.1177/1526924820958129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular assist device (VAD) patients are at high risk for morbidities and mortality. One potentially beneficial component of the Joint Commission VAD Certification process is the requirement that individual VAD programs select 4 performance measures to improve and optimize patients' clinical outcomes. PROBLEM STATEMENT Review of patient data after our program's first certification visit in 2008 showed that, compared to national recommendations and published reports, our patients had suboptimal outcomes in 4 areas after device implantation: length of hospital stay, receipt of early (<48 hours) postsurgical physical therapy, driveline infection incidence, and adequacy of nutritional status (prealbumin ≥18 mg/dL). METHODS Plan-Do-Study-Act processes were implemented to shorten length of stay, increase patient receipt of early physical therapy, decrease driveline infection incidence, and improve nutritional status. With 2008 as our baseline, we deployed interventions for each outcome area across 2009 to 2017. Performance improvement activities included staff, patient, and family didactic, one-on-one, and hands-on education; procedural changes; and outcomes monitoring with feedback to staff on progress. Descriptive and inferential statistics were examined to document change in the outcomes. OUTCOMES Across the performance improvement period, length of stay decreased from 40 to 23 days; physical therapy consults increased from 87% to 100% of patients; 1-year driveline infection incidence went from 38% to 23.5%; and the percentage of patients with prealbumin within the normal range increased from 84% to 90%. IMPLICATIONS Performance improvement interventions may enhance ventricular assist device patient outcomes. Interventions' sustainability should be evaluated to ensure that gains are not lost over time.
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Affiliation(s)
- Kathleen L Lockard
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Elizabeth Dunn
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Nicole Kunz
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Amanda Pearsol
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Richard D Schaub
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Donald A Severyn
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Douglas Lohmann
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Michael McCall
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Brian Morelli
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine, 6429Stanford University School of Medicine and Stanford Cardiovascular Institute, Palo Alto, CA, USA
| | - Robert L Kormos
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Division of Cardiothoracic Surgery, Department of Surgery, 6614University of Pittsburgh, PA, USA
| | - Christopher M Sciortino
- Heart and Vascular Institute, 6595University of Pittsburgh School of Medicine and Medical Center and UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Division of Cardiothoracic Surgery, Department of Surgery, 6614University of Pittsburgh, PA, USA
| | - Mary Amanda Dew
- Department of Psychiatry, 6614University of Pittsburgh, PA, USA.,Department of Psychology, 6614University of Pittsburgh, PA, USA.,Department of Epidemiology, 6614University of Pittsburgh, PA, USA.,Department of Acute and Tertiary Care Nursing, 6614University of Pittsburgh, PA, USA.,Department of Biostatistics, 6614University of Pittsburgh, PA, USA
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Kato NP, Jaarsma T, Casida JM, Lee CS, Strömberg A, Gal TB. Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation. Prog Transplant 2019; 29:335-343. [DOI: 10.1177/1526924819874358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD.Methods:We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity.Results:A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items.Conclusion:The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.
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Affiliation(s)
- Naoko P. Kato
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Sweden
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Japan
| | - Tiny Jaarsma
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Sweden
| | - Jesus M. Casida
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Christopher S. Lee
- Oregon Health and Science University School of Nursing and Knight Cardiovascular Institute, Portland, OR, USA
- Boston College, Willian F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Anna Strömberg
- Division of Nursing Science, Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel
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Implications of Transitional Care Interventions on Hospital Readmissions in Patients With Destination Therapy Left Ventricular Assist Devices. Res Theory Nurs Pract 2019; 33:81-96. [PMID: 30796149 DOI: 10.1891/1541-6577.33.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The rising number of patients with a left ventricular assist device (LVAD) require care management to successfully transition home after implantation. These patients and their families need to manage their heart failure, and the complexities of an LVAD and the associated lifestyle modifications. Translating knowledge of transitional care interventions in patients with chronic diseases to those with an LVAD may provide valuable insight. To help inform the furthering of care transitions in the LVAD patient population, an integrative review was conducted. AIM The aim of this review was to explore the transitions of care interventions of care in patients and its potential for application in the destination therapy LVAD. METHODS This integrative review was guided by the Whittemore and Knafl's methodology. RESULTS A total of 12 articles from 264 retrieved articles met inclusion criteria and were included in the literature review. DISCUSSION This review identified that evidence-based transitional care interventions have been shown to decrease avoidable rehospitalization, the associated costs, and improve quality of life when compared to usual care. IMPLICATIONS FOR PRACTICE A common feature of transitional care interventions is the inclusion of nurse leadership. Nurses should be prepared to participate in transitional care interventions to optimally improve outcomes for patients with heart failure and potentially those with an LVAD. Additionally, to make transitional care interventions more effective they should be implemented with moderate intensity or greater. CONCLUSION This review provided information supporting the trialing of transitional care interventions in patients with an LVAD and suggests pilot research to optimize interventions for this population.
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Iseler J, Fox J, Wierenga K. Performance Improvement to Decrease Readmission Rates for Patients With a Left Ventricular Assist Device. Prog Transplant 2018; 28:184-188. [PMID: 29558876 DOI: 10.1177/1526924818765820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The 30-day readmission rate for patients with a left ventricular assist device implantation at a large, urban, Midwest hospital system (from October 2013 to September 2014) was estimated at 32.1%. PROBLEM STATEMENT Readmission rates were a concern at this facility. Review of the readmissions, change in practice, and home expectations of patients and families have identified an opportunity to improve the transitions of care for this left ventricular assist device (LVAD) program. Therefore, the purpose of this project was to evaluate the effectiveness and feasibility of a transitional care model (TCM) for care of patients with left ventricular devices. METHODS Ten patients were enrolled in the pilot that was implemented in June 2015. A transitional care nurse trained to support patients with ventricular assist devices was used to facilitate patient flow. The goal was to create an individualized plan for the development or improvement of self-management skills to decrease readmission rates. The transitional care nurse collaborated with the ventricular device team. OUTCOMES The 30-day readmission rate during the pilot was 14.3% compared to the previous annual overall rate of 42.6%. IMPLICATIONS FOR PRACTICE Based on these results, further research is recommended into interventions consistent with the TCM to advance care coordination and to facilitate care transition in the this fragile patient population.
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Affiliation(s)
- Jackeline Iseler
- 1 College of Nursing, Michigan State University, East Lansing, MI, USA
| | - John Fox
- 2 Priority Health, Grand Rapids, MI, USA
| | - Kelly Wierenga
- 3 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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