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Date of Award

4-26-2018

Degree Type

Restricted Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Thomas J. Blodgett

Abstract

Purpose: Heart Failure (HF) is a chronic, progressive disease affecting an estimated 5.7 million people in the United States (CDC, 2016), with 670,000 new patients diagnosed each year. HF also represents the greatest cause of hospital readmissions among Medicare patients with 30% being readmitted to the hospital or dying within 90 days after discharge (Alspach, 2015). Estimated annual cost of HF readmissions is over $2 billion for Medicare alone (Centrella-Nigro et al., 2016). Under the Hospital Readmission Reduction Program of the Patient Protection and Affordable Care Act, there is a penalty for hospitals that have higher than average 30-day HF readmission rates. The purpose of this project is to determine if the implementation of a nurse-led, structured telephone support (STS) intervention for HF patients discharged from the hospital to their home will reduce 30-day HF readmission rates.

Strength of evidence: A literature search was conducted using seven databases, which yielded 13 relevant articles. Levels of evidence was determined by the rating scale of Melynk and Fineout-Overholt, (2011) and ranged from I to III. The Critical Appraisal Skills Programme (CASP) tool evaluated quality of evidence.

Implemented practice change: At a two-campus hospital system with a stand-alone cardiopulmonary rehab institute, two cardiac rehabilitation nurses will conduct a 2-month follow-up project for discharged HF patients. A STS intervention and semi-scripted form provided by the American Heart Association will guide the frequency of telephone calls made and questions asked by the nurses. Calls will be made to patients within 24-72 hours after discharge, then once a week for two weeks. Follow-up calls will continue every other week for the remainder of the two months.

Implementation strategies and stakeholders: The Transitional Care Model by Dr. Mary Naylor will provide the theoretical framework and The Diffusion of Innovation by Everett Rodgers will guide implementation. Stakeholders include administrative management, cardiologists, and cardiac rehabilitation nurses.

Evaluation methods: Descriptive statistics and a chi-square test of independence will be used. Results: STS did not reduce 30-day HF readmissions.

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