Preventing Readmission in Coronary Artery Bypass Graft Surgery Patients

Effect of a Nurse Practitioner Directed Discharge Intervention on 30 day Hospital ReadmissionLeonora Abiera DNP student, ANP-C Stony Brook University School of NursingEffect of a nurse practitioner directed discharge intervention on 30 day hospital readmission.1Background

Readmissions are costly and are associated with increased mortalityCoronary artery bypass graft surgery (CABG) readmissions remain highReadmissions are attributed to poor discharge planning$ 17 billion a year1 in 5 medicare patients$100,000/ cabg cases 7% to 24% readmssion rate2

Purpose

To examine the effect of a nurse practitioner (NP) discharge intervention on the 30 day readmission rate of elderly patients after CABG surgery.

NP education on readmission rate and readiness to hosp. discharge.3Theoretical FrameworkDiffusion of Innovation

InnovationNP discharge education

DiffusionCommunicateinnovation Cardiac Surgery Readmission preventionDisseminateActionsAwarenessAdoptImplementInstitutionalizeSampleInclusion CriteriaAge 65 years and olderCommunicates in English languageFirst and elective CABG surgeryMust have a working telephone 5SampleExclusion CriteriaPrior open heart surgeryUnable to communicate in EnglishCognitive impairment or mental illnesssignificant hearing problems

MethodsQuasi Experimental Design-pilot study Convenience samplingStandard group routine hospital discharge Experimental group routine hospital discharge plus NP education

Pilot study feasibility study for a larger scale study7

MethodsMeasurements Demographic QuestionnairePatient Learning Need Scale (PLNS)-self report measure of important topics to learnReadiness to Hospital Discharge Scale (RHDS)-Self report measure of readiness to hospital discharge

.

Demographic- age, gender, ethnicity, education, marital status, employment, living arrangement, comorbidities

PLNS is a self report measure with a 6 point likert scale. Rates how important it is to learn topics ie; meds, adl, complications, symptom management.

RHDS: 21-item, self-report questionnaireMeasures perceptions of readiness to discharge: personal status, knowledge, coping, support

8Data analysisStatistical Package for Social Sciences statistic software (SPSS)Descriptive statistics for sample characteristicsChi square, Independent t-test, Pearson correlation to explore relationships of variablesResults Demographic N=68Age 65 to 88 M=72Male 54 (79%)Married 51 (75%)Caucasian 48 (71%)College education 37(54%)Live w others 53 (78%)Unemployed 40 (49%) Presence of 3 to 4 comorbid 42 (62%)

CAD 59 (87%)HTN 52 (76%)High Chol 44 (65%)

Total comorbidities for most samples: 3 comorbidities 29 (42.6%) 4 comorbidities 17 (25%)11Readmission in 30 days

Readmit total group NO= 61 (90%) and YES= 7 (10%)Standard 5 Treat 2.12

ResultReadmission rate in 30 days did not differ between the standard and intervention group There was a significant relationship between readiness to hospital discharge and patients learning needs13

Implication to nursing

Readmission is viewed as a poor outcome of health care. NPs are in a position to optimize inpatient discharge teaching and help patients deal with the stress of surgeryAssessment of learning needs and readiness to hospital discharge is essential for a successful discharge.