Date of Award

5-5-2015

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Theresa A. Kessler

Abstract

Coronary artery bypass graft (CABG) surgery is one of the most frequent and expensive cardiac surgical procedures in the U.S. today. Complications from CABG surgery are one of the top causes of 30-day hospital readmissions. Readmissions after CABG surgery are often preventable and add to health care costs. Recent government legislation mandates penalties for hospitals with excess readmission rates. The purpose of this evidence-based practice project was to determine if implementation of best practice recommendations effected 30-day readmission rates following CABG surgery. A critical appraisal of the literature was conducted to identify best practice recommendations. The Iowa model and Lewin’s Change Theory guided this project. The project included 127 patients who had undergone isolated CABG surgery. The best practice model included writing order sets, revising patient education material, developing a discharge check list, and providing staff education. Sixty-five patients were in the pre-intervention group and 62 in the post-intervention group. Demographic characteristics of the two groups were compared. Using an independent samples t-test, age and LOS were not significantly different (p > .499), and using a chi-square test of independence, no significant differences were found for gender, race, tobacco use, secondary diagnosis or surgery timing (p > .291). Chi-square tests revealed no significant difference in the prescribing of BB and statin medication (p > .089), while a significant difference was found in the prescribing of aspirin and ACEl/ARB medication (p >.000). A significant difference was found when comparing referrals to care management (p =.004), homecare (p = .000), and cardiac rehabilitation (p = .000). Use of the cardiac surgery education booklet, education specific to cardiac diet (p = .000), smoking cessation (p = .000) and securing of 14-day appointments also showed a significant difference between groups (p > .000) Analysis of 30-day re-admission rates was done using a Chi-square test and revealed a significant difference in the preintervention group (16.9%) and the post intervention group (4.8%) ( 2(1) = 4.724, p = .000). Results demonstrated consistent use of best practices following adult CABG surgery reduced 30-day hospital re-admission rates. Replication of this evidence-based practice project has been adopted by the project manager's institution.