1
|
Marzinski S, Melrose D, Moynihan T, Hlebichuk J, Liao Y, Hook M. Knowing the Patient: Understanding Readmission Reasons in Complex Heart Failure. J Cardiovasc Nurs 2024; 39:438-448. [PMID: 38015045 DOI: 10.1097/jcn.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity. OBJECTIVE The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences. METHODS A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses. RESULTS Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%). CONCLUSIONS Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.
Collapse
|
2
|
Amdani S, Lopez R, Schold JD, Tang WHW. 30- and 60-Day Readmission Rates for Children With Heart Failure in the United States. JACC. HEART FAILURE 2024; 12:83-96. [PMID: 37943220 DOI: 10.1016/j.jchf.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Studies on readmission for pediatric heart failure (HF) patients is sparse. OBJECTIVES This study evaluated 30- and 60-day readmission rates in pediatric HF patients from 2010 to 2019. METHODS The authors used data from the Nationwide Readmission Database to evaluate trends in 30- and 60-day hospital readmissions among pediatric patients with HF and compare them with adults with HF. Readmissions were also stratified by sex, diagnosis, neighborhood income, and hospital volume. RESULTS There were 84,731 hospital admissions for HF. Compared with children without HF, those with HF were older, had Medicare/Medicaid insurance, and resided in micropolitan areas and low-income neighborhoods. The 30- (19.5% vs 3.1%) and 60-day (27.5% vs 4.3%) all-cause readmission rates were higher for children with HF compared with those without HF. Compared with children without HF, lengths of stay, deaths, and costs related to their readmission were higher for children readmitted with HF (P < 0.05 for all). There was no significant decline in pediatric HF-related 30- or 60- day readmissions during the study period overall, or for those with congenital heart disease (P > 0.05), unlike adult HF readmissions (P < 0.01). Infants were at highest risk, and readmission rates for teenagers are rising. CONCLUSIONS The 30- and 60-day readmission rates for pediatric patients with HF in the current era is high (∼20% and 30%, respectively). Unlike adult HF, pediatric HF readmission rates have not declined. Pediatric HF patients readmitted to the hospital have higher death rates and greater resource utilization than patients without HF. National measures to decrease readmissions for pediatric patients with HF is warranted.
Collapse
Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
| | - Rocio Lopez
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Wang Z, Walsh S, Tocchi C, Zhang Y, Chyun D. Nurses' knowledge of heart failure assessment and management: A cross-sectional survey. Heart Lung 2023; 58:82-90. [PMID: 36434826 DOI: 10.1016/j.hrtlng.2022.11.008] [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: 08/24/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nurses' knowledge of heart failure (HF) is highly variable, ranging from expert to poor, potentially leading to inadequate self-care. OBJECTIVES (1) document the knowledge variation of HF assessment and management among specialist and generalist nurses; (2) determine factors that may be associated with nurses' knowledge; and (3) describe nurses' views of knowledge deficits and ways to improve nurses' knowledge to better meet the needs educational interventions. METHOD Members of the American Association of Heart Failure Nurses and Registered Nurses were invited to participate in a cross-sectional survey. Independent samples t-test, chi-square, and linear regression were used for quantitative analysis. Text analysis was applied to analyze the themes of qualitative comments. RESULTS A total of 918 nurses completed the survey. Specialist nurses had higher scores than generalist nurses with statistically significant F-test for diet, fluid, signs/symptoms, medication, and exercise. Both specialist and generalist nurses were least knowledgeable about dry weight, asymptomatic hypotension, and transient dizziness. Being a specialist nurse was associated with higher level of knowledge scores. Years of experience and race were significant factors associated with knowledge scores in generalist nurses. Confidence level and race were significant predictors for specialist nurses. Three themes emerged regarding the cause of nurses' insufficient knowledge and several approaches were provided. CONCLUSIONS Specialist nurses are not only knowledgeable, but their knowledge levels are less variable compared to generalist nurses. There is a need to identify additional factors that may potentially influence nurses' knowledge, contributing to the effectiveness of interventions.
Collapse
Affiliation(s)
- Zequan Wang
- University of Connecticut School of Nursing, Storrs, CT, United States; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, United States.
| | - Stephen Walsh
- University of Connecticut School of Nursing, Storrs, CT, United States; University of Connecticut School of Medicine, Storrs, CT, United States
| | - Christine Tocchi
- University of Connecticut School of Nursing, Storrs, CT, United States; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, United States
| | - Yiming Zhang
- University of Connecticut Department of Statistics, Storrs, CT, United States
| | - Deborah Chyun
- University of Connecticut School of Nursing, Storrs, CT, United States
| |
Collapse
|
4
|
Improved 30-Day Heart Failure Readmissions Following Implementation of an Advanced Cardiovascular Education (ACE) Academy. J Nurs Care Qual 2022; 37:300-306. [DOI: 10.1097/ncq.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
Imanuel Tonapa S, Inayati A, Sithichoksakulchai S, Daryanti Saragih I, Efendi F, Chou FH. Outcomes of nurse-led telecoaching intervention for patients with heart failure: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2021; 31:1125-1135. [PMID: 34535943 DOI: 10.1111/jocn.16025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies have identified that nurse-led telephone health coaching benefited the continuity of care in patients with heart failure. However, the effect of nurse-led telephone health coaching remains inconclusive among the previous studies. AIM This review aimed to determine the effects of nurse-led telecoaching among patients with heart failure. DESIGN This study was a systematic review and meta-analysis of randomised controlled trials. This study was reported in accordance with the PRISMA guideline. METHODS Seven databases (PubMed, Embase, CINAHL, Web of Science, MEDLINE, Cochrane library and Ovid) were electronically searched up to 20 October 2020. The eligibility criteria were a randomised controlled trial study on heart failure patients, with the intervention led by a nurse through telephone coaching. Two authors independently evaluated the methodological quality using the modified Jadad scale. The Comprehensive Meta-Analysis software version 3.0 with a random effect model was used to conduct a meta-analysis, and Begg's and Egger's tests were performed to assess publication bias. Furthermore, sensitivity analysis was carried out. RESULTS A total of 12 randomised controlled trials were met eligibility criteria and representing 1938 heart failure patients. The results showed that the nurse-led telecoaching significantly enhanced patients' self-care behaviour (SMD = .84, 95%CI [0.45-1.24], p < .001) and improved quality of life (SMD = .23, 95%CI [0.06-0.39], p = .007). CONCLUSION Nurse-led telecoaching appears to enhance self-care behaviour and improve quality of life in patients with heart failure. Further research needs to build the evidence for nurse-led telecoaching intervention, including understanding its mechanisms of action (e.g. frequency, components) and identifying its moderating factors. RELEVANCE TO CLINICAL PRACTICE Implementation of nurse-led telecoaching is deemed helpful in promoting continuity of care because it was an accessible and sustainable intervention to improve patients' self-care and quality of life.
Collapse
Affiliation(s)
- Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Aini Inayati
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Faculty of Health Science, Alma Ata University, Yogyakarta, Indonesia
| | - Siriluk Sithichoksakulchai
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Fundamental Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
6
|
Effects of Predischarge Patient Education Combined With Postdischarge Follow-Ups on Self-Care, Readmission, Sleep, and Depression in Patients With Heart Failure. J Nurs Res 2021; 28:e112. [PMID: 32694457 DOI: 10.1097/jnr.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with heart failure rarely engage in adequate self-care. Greater emphasis on self-care discharge readiness is needed. PURPOSE This study examined the effects of a predischarge educational program combined with 1 year of postdischarge follow-up on self-care behaviors, readmission, sleep quality, and depression in patients with heart failure. METHODS A longitudinal, nonequivalent two-group pretest-posttest design was used. The intervention group received tailored education and follow-ups, whereas the control group received routine predischarge heart-failure education from direct care nurses only. Measurements included the self-care maintenance and self-care management subscales of the Self-Care of Heart Failure Index, Pittsburg Sleep Quality Index, Patient Health Questionnaire-9, and readmission rate. Data obtained at baseline and at 1, 3, 6, and 12 months postdischarge were analyzed using linear mixed models with both intention-to-treat and per-protocol approaches. The propensity score was used to adjust for the confounding effects of the New York Heart Association functional class and left ventricular ejection fraction. RESULTS Of the 62 patients with heart failure (28 in the intervention group and 34 in the control group) who were sampled at baseline, 47 (n = 25 vs. n = 22) provided data over the entire course of this 1-year study (76% retention rate). The per-protocol analysis did not find significant differences for any variables. However, the intention-to-treat analysis showed that the intervention group significantly improved in self-care maintenance at 6 months and self-care management at 12 months after hospital discharge, with fewer, albeit not significantly fewer, first and subsequent hospital readmissions than the control group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The effect of this intervention was not found to be substantial, indicating a need to design more efficacious and powerful interventions. Hospitalized patients must receive patient education before discharge to foster their self-care knowledge and skills regarding self-care at home. Strategies are needed to help nurses provide patient education in a time-efficient manner.
Collapse
|
7
|
Vuckovic KM, Bierle RS, Ryan CJ. Navigating Symptom Management in Heart Failure: The Crucial Role of the Critical Care Nurse. Crit Care Nurse 2021; 40:55-63. [PMID: 32236426 DOI: 10.4037/ccn2020685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
High-acuity, progressive care, and critical care nurses often provide care for patients with heart failure during an exacerbation of acute disease or at the end of life. Identifying and managing heart failure symptoms is complex and requires early recognition and early intervention. Because symptoms of heart failure are not disease specific, patients may not respond to them appropriately, resulting in treatment delays. This article reviews the complexities and issues surrounding the patient's ability to recognize heart failure symptoms and the critical care nurse's role in facilitating early intervention. It outlines the many barriers to symptom recognition and response, including multimorbidities, age, symptom intensity, symptom escalation, and health literacy. The influence of self-care on heart failure management is also described. The critical care nurse plays a crucial role in teaching heart failure patients to identify and respond appropriately to their symptoms, thus promoting early intervention.
Collapse
Affiliation(s)
- Karen M Vuckovic
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Rebecca Schuetz Bierle
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Catherine J Ryan
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| |
Collapse
|