Question

In a large teaching hospital, there is a high rate of readmission for patients with congestive heart failure (CHF) who are being treated at the facility. The chief nursing officer (CNO) wants to know the cause of the readmissions, as the rate at this facility is almost twice that of competing healthcare entities in the area. The CNO works with the nursing researchers at the university to address this situation.

The researchers begin to scour the electronic health records (EHRs) of more than 15,000 CHF hospitalizations in the past 4 years to determine the cause of the situation. As they begin to understand this dataset, they are able to build a data mining model using algorithms to discover patterns and relationships in the data. Based on the old data, they determine that the key factor for readmission was the length of time it took to follow up at home with discharged patients.

In response to this new knowledge, a program in which nurses contact patients with CHF the day after their discharge by phone was developed, and a home visit is scheduled for the second day postdischarge to ensure a smooth transition to home or an assisted living facility. This follow-up within the first 4 days of discharge has reduced readmissions by 40%. The model that was used with the old data is being applied to the new data.

• What assessment information would be important to include in the data set?
• What information would be a priority?
• What additional actions would most likely achieve the desired outcome for patients with congestive heart failure (CHF)?
• Which actions are the most appropriate and how should they be implemented?
• What patient assessment(s) would indicate the implementation of the discharge program was effective in reducing readmission rates?

Answer 1

Answer

1) Assessment information in data set should include:

a) baseline vital signs including an apical pulse.

b) warning signs of worsening CHF like sudden weight gain, swelling in the feet, ankles and abdomen, shortness of breath even at rest.

c) assessment of lung sounds for congestion, rales.

d) evaluation of fluid status.

2) The most prioritized information includes whether the patient experiences any shortness of breath not related to exercise.

3) Additional actions to achieve the desired outcome for patients with CHF are educate the patient about diet management, importance of less fluid intake and administration of medication at proper time.

4) Most appropriate action should be taken to reduce cardiac demand by avoiding fatty cuts of meat in their meals, removal of excess fluid intake with diuretic medications and by limiting fluid intake.