Improved 30-Day Heart Failure Readmissions Following Implementation of an Advanced Cardiovascular Education (ACE) Academy

Abstract

Background: Heart failure readmissions are common, though some are preventable through evidence-based management. Local Problem: Despite outperforming national benchmarks for 30-day readmissions, compliance with an evidence-based institutional heart failure management pathway was inconsistent. The purpose of this project was to reduce 30-day heart failure readmission rates through an educational intervention and an electronic health record (EHR) redesign. Methods: The cardiac services nursing leadership team conducted an education and documentation needs assessment to identify knowledge gaps and practical barriers to effective utilization of evidence-based interventions for heart failure management. Interventions: This intervention included an Advanced Cardiovascular Education (ACE) Academy and an EHR workflow redesign for clinical and supportive nursing staff. Results: The 30-day heart failure readmission rates reduced immediately following the intervention, and rates continued to decrease over a 3-year follow-up. Conclusions: Even among hospitals outperforming national benchmarks, 30-day heart failure readmissions can be reduced and sustained with enhanced education and EHR redesign.

The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review

“…Of these studies, detailed assessments resulted in the review of 15 studies meeting all inclusion criteria. Out of the 15 studies, 10 studies utilized quantitative design (Carthon et al, 2015;Gilbert et al, 2021;Hoyer et al, 2018;Kara et al, 2015a;Lasater & Mchugh, 2016;Ma et al, 2015;Mathews et al, 2014;McHugh & Ma, 2013;Oliver et al, 2022;Shirey et al, 2019), and five utilized a qualitative approach (Coyne et al, 2016;Feo et al, 2022;Glette et al, 2018;Okoniewska et al, 2015;Udod et al, 2022). For search strategy, see Figure 1.…”

“…A review of the study designs across this group of quantitative articles revealed notable limitations and flaws that threatened the internal and external validity of research findings. Out of the 10 studies, 5 used quasi-experimental design (Hoyer et al, 2018;Kara et al, 2015a;Mathews et al, 2014;Oliver et al, 2022;Shirey et al, 2019) and 1 used randomized controlled trial (Gilbert et al, 2021), other 4 used a descriptive cross-sectional design. Since the majority of the studies used a cross-sectional design, establishing temporal precedence was not possible; thus, the ability to determine the causal relationship between leadership and readmission was limited.…”

“…On the other hand, the use of a control group helps researchers assess the magnitude of the reduction in readmission rates. The other four quasi-experimental studies used a two group pre and posttest design (Hoyer et al, 2018;Mathews et al, 2014;Oliver et al, 2022). However, these studies lacked random assignment, which could mean that participants in the intervention and control group were initially nonequivalent.…”

“…In the other four studies, researchers counted disease specific readmission, readmission within 30 days for the same condition. Data on patients' readmission were collected either from the hospital-level administrative discharge data (Kara et al, 2015a;Lasater & Mchugh, 2016;Mathews et al, 2014, Oliver et al, 2022 or from state-level discharge databases (Carthon et al, 2015;Lasater & Mchugh, 2016;Ma et al, 2015;McHugh & Ma, 2013). Using state-level-discharge databases allows researchers to track patients' readmissions, using patients' unique identifier, even when patients were readmitted to a different hospital than they were discharged from on their prior admission.…”

“…Eight quantitative (Carthon et al, 2015;Hoyer et al, 2018;Kara et al, 2015b;Mathews et al, 2014;Oliver et al, 2022;McHugh & Ma, 2013) and the five qualitative studies discussed the mechanism and role of leadership on reducing the incidence of readmission. Leadership indirectly influences patients' readmission rate through various processes, including developing effective care plans (Carthon et al, 2015), participating in interdisciplinary rounds that set clear patient discharge goals (Kara et al, 2015b), improving the documentation process (Glette et al, 2018), involving effective interprofessional collaboration and teamwork in which nurses have autonomy to make decisions regarding patients' readiness for discharge (Mathews et al, 2014;McHugh & Ma, 2013;Shirey et al, 2019), and establishing coordination between various health services (Glette et al, 2018).…”