Question

Capstone Project: Milestone 2: Design Proposal

Stakeholders

You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.).

Determine Responsibility of Team Members

Why are the members chosen important to your project? What are their roles?

Evidence

Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines? Briefly discuss the strength of this research. This is not where you describe the results of your studies. This is done in the following steps.

Summarize the Evidence

In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.

Develop Recommendations for Change Based on Evidence

What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program.

Translation

Action Plan

You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study? What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results.

Process, Outcomes Evaluation and Reporting

What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders?

Identify Next Steps

How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent?

Disseminate Findings

How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)?

Conclusion

Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan.

Answer 1

Reducing Hospital Readmissions with Telephone Follow-ups

There have been studies that showed telephone follow-ups after patients are discharged can decrease readmissions after joint surgery for the older adult population. The issues identified, because of not following up with the patient are falls and surgical complications. Evidence shows providing interventions which included telephone follow-ups alone, or in combination with other components reported 30day readmission outcomes were effective (Jayakody et al., 2016).

Change Model Overview

The ACE Star Model is the relationship between various of stages of knowledge being transformed as newly discovered knowledge is moved into practice. When nurses want to facilitate change, the ACE Star Model places their previous scientific work within the context of evidence base practice (Stevens, 2004). It serves as an organizer for examining and apply evidence base practice and help nursing flow into the formal network of evidence base practice.

Define the Scope of the EBP

The issue identified is the increased number of readmissions after a joint surgery by the older adult population from falls and surgical complications are mostly due to telephone follow-ups are not being initiated by a hospital-based health professional after patients are discharged from hospital to home (Mistiaen&Poot, 2006).

Charlotte area hospitals receive reduced payments from Medicare due to a federal program that penalizes hospitals for having too many patients readmitted for additional treatment within 30 days of their last hospital stay. Eighteen percent of Medicare patients discharged from the Charlotte area hospitals have a readmission within 30 days of discharge accounting for $15 billion in spending based on a report from Medicare Payment Advisory Commission. Carolinas Health Care did not provide estimates however some other local officials did. Forexample, Caro Mont hospital paid $115,000 in fines in 2013 and $99,000 in 2014 but has not paid no other penalty since then.

Stakeholders

The team members needed to carry out this research project would be nurses including nurse managers, clinical educator, head administrator and patients/families.

Determine Responsibility of Team Members

Each team member chosen plays a very important role in the implementation of the research project. The nurse manager can help find the existing research study and the nursing guidelines while helping to initiate the new policy and procedure. Other nurses are needed to carry out the interventions for the outcome to be effective. The head administrator should be notified about any changes or plans to be implemented in the hospital. They must assure the performance of hospital nursing and have control over hospital cost. The patients and families will play the major role in the research to show if the research was valid.

Evidence

            The increase in patient’s readmissions have been noticed on the unit from the older adult populations after surgery due to complications and dislocations from falls. Studies have shown a lot of readmissions are preventable by patient follow-ups after initial hospital visits. Initiatives to improve hospital quality of care include assessing the hospital readmission rates. The overall unplanned readmission rate was 4% at 30 days and 7% at 90 days based on a study done by Schairer, Sing, Vail, and Bozic (2014), after total hip arthroplasty surgery. This research will determine if telephonic outreach is able to reduce hospital readmissions 30 to 90 days after discharge.

Summarize the Evidence

Telephone follow-up is a good way of exchanging information, providing health education and advice, managing patient’s symptoms, recognizing complications early, giving reassurance and providing quality post care service (Mistiaen&Poot, 2006). Majority of readmissions are preventable through effective discharge planning and patient follow-up after the initial hospital visit. These recurrent hospitalizations are responsible for health care spending (Harrison, Hara, Pope, Young and Rula, 2011). Search for database from The National Research Register and Controlled Clinical Trials may be used.   Randomized controlled trials will be initiated for patients discharged with outcomes being measured within 3 months (Mistiaen&Poot, 2006). The patient’s will receive a telephone call from a nurse to verify if they received discharge instructions and understood them. Also, making sure they are aware of their follow-up visits and instructions on how to avoid additional acute events and safety measures (Harrison et al., 2011).

Develop Recommendations for ChangeBased on Evidence

To implement the change based on evidence there should be a detailed plan to carry out the research survey and communicated with everyone involved. Any training needed for the nurses that would be making the calls should also be included. It is important to explain to the patient’s and families why the survey is taking place and the importance of it to get honest answers.

Translation

Action Plan

To achieve the final steps, the systematic and analysis reviews will be researched including case studies and reports of the current outcome evaluations.This will include any clinical experts involved in the project. The next step would be to have a meeting with staff and administration to let them know what is trying to be achieved and recruit anyone who would like to be on the team to carry out the research. Patients will receive at least two calls by a nurse within a week after discharge. The survey will be done when patients are readmitted or has been readmitted previously.

Process, Outcomes Evaluation and Reporting

A randomized survey will be conducted with patients and families. The desired outcome will be a reduction in hospital readmissions. The evaluation of the outcome will be conducted within 30 days by researching hospital records through the Medicare Payment Advisory Commission and patient satisfaction surveys.

Identify Next Steps

This research will start out on one unit, the joint surgery floor. After reviewing the outcome of the project and determining whether it was effective, then the research project can be implemented on all other units in the hospital. The Medicare Payment Advisory Commission base their report on the overall hospital readmissions unlike the patient satisfaction surveys. The interventions implemented to make the outcome effective must be added to the hospitals policies to make it a permanent change.

Disseminate Findings

The research finding will be communicated by hospital newsletters, written articles, websites and videos. The hospital staff will be notified of the findings by emails and staff meetings.

Conclusion

There has been an issue identifying that patients are having falls and surgical complications which in turns causes readmissions to the hospital mainly because of health professionals are not following up with patients via telephone after discharge from the hospital to the home settings. Telephone follow-ups can provide the patient with information and education to reduce re-hospitalizations. Readmissions that are preventable can be costly to the health care industry. Medicare payments are reduced because of this issue and hospitals are fined.

The ACE Star Model organizes both old and new concepts of improving care into a whole and provides a framework with which to organize evidence base practice approaches. Starting with discover research where the new knowledge is discovered through a quantitative study. Secondly, the evidence study showing the issue of thisproblem with systematic reviews. Then the translation to guidelines is done by providing the evidence collected to hospital staff and administration about wage labor and time it would take to put the project into the setting environment. The integration into practice would be the start of the research by making the phone calls and collecting surveys. Finally, the evaluation is to assess the outcome. The goal is reduced hospital admissions and patient satisfaction. These changes can be maintained through policies and procedure acts, education and accountability.

References:

Harrison, P.L., Hara, P. A., Pope, J. E., Young, M.C., &Rula, E.Y. (2011). The Impact of Post -discharge Telephonic Follow-up on Hospital Readmissions. Population Health Management, 14(1), 27-32. doi:10.1089/pop.2009.0076

Jayakody, A., Bryant, J., Carey, M., Hobden, B., Dodd, N., & Jason-Fisher, R. (2016). Effectiveness of interventions utilizing telephone follow-up in reducing hospital readmission within 30 days for individuals with chronic disease: a systematic review. BMC Health Services Research, 16(1). doi:10.1186/s12913-016-1650-9

Medicare Payment Advisory Commission (MEDPAC) Retrieved from www.medpac.gov

Mistiaen, P., &Poot, E. (2006). Telephone follow-up, initiated by a hospital-based health professional, for post-discharge problems in patients discharged from hospital to home. Cochrane Consumers and Communication Group.

Readmissions will cut Medicare payments to Some Charlotte….Retrieved from www.charlotteobserver.com/living/article9198686.html

Schairer, W.W., Sing, D.C., Vail, T.P., &Bozic, K.J. (2014). Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty. Clinical Orthopedics and Related Research, 472 (2), 464-470. Retrieved from http://doi.org/10.1007/s11999-013-3121-5.

Stevens, K.R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-based Practice. The University of Texas Health Science Center at San Antonio. Retrieved from www.acestar.uthscsa.edu