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2021 prov rn wa; 2021 prov rn poster; washington; spokane; phfh; pshmc
Cardiology | Nursing
Background: Across the U.S., 20% of cardiothoracic surgery patients who are discharged to home experience unplanned readmission within 30 days of discharge. Readmissions and postsurgical complications are associated with poor patient outcomes, increased mortality rates, and increased cost of healthcare. Evidence-based recommendations for reducing preventable readmission are limited, although there is some indication that high quality pre-operative and discharge education can reduce this burden. Providing appropriate patient education at time of discharge from acute care to home regarding medication adherence, prescheduled follow-up appointments, wound management and monitoring, and symptom management education is theorized to have a significant positive impact on patient outcomes.
Purpose/aims: The primary purpose of this program evaluation was to evaluate 30-day readmission rates at a large medical center in the Pacific Northwest prior to, during, and after the implementation of a comprehensive program of patient education designed to support patients undergoing elective cardiothoracic surgery at an outpatient cardiothoracic clinic staffed by cardiothoracic surgeons who performed operations at the medical center.
Methods/Approach: This program evaluation used an observational design. The retrospective analysis of a de-identified dataset included 9,454 patients (18-100 years of age) who underwent a cardiothoracic procedure (coronary artery bypass graft, valve replacement, valve repair, wedge resection, or lobectomy) with providers at the outpatient clinic between 2014 and 2020. The dataset included the following variables of interest: age, gender, BMI, race, ASA score (representing comorbidity), surgery type, length of surgery, marker of 30-day readmission, days since surgery, and occurrence of 30-day readmission as the dependent variable. Data were explored descriptively to assess variability and normalcy before performing a time series analysis to evaluate trends in readmission rates.
Results: There was a statistically significant (p=<0.001) 6% decrease between average readmissions prior to and post program implementation. Patients with comorbidities are twice as likely to experience readmission than those with a low co-morbidity index [1.9 (1, .074), p =<.001]. Hospital readmission rates fall below the national average at 13.8% vs. 15.2% overall and 11.7% vs. 14.9% for CABG.
Conclusion: The time series analysis represents the highest level of observational evidence available, and in this case, suggests that a decrease in readmissions is associated with the implementation of a comprehensive patient education program by the outpatient clinic. The results of this evaluation contribute to the small body of evidence currently available regarding methods to reduce unplanned readmission rates among surgical patients and may be helpful to other surgical clinics who wish to improve their preventable 30-day readmission rates.
Implications for practice: High quality, patient-centered nursing care is essential to meeting national healthcare goals related to patients post-surgery. The implementation of a comprehensive educational program at one cardiothoracic clinic appears to be helping patients avoid unnecessary hospital readmissions following open heart surgery.
Conference / Event Name
2021 Providence RN Conference
Havel, Sheri; Colorafi, Karen; and Beqiri, Mirjeta, "Evaluation of a Coronary Artery Bypass Graft Care Steps Program" (2021). 2021 Providence Nurse Research Conference. 22.