Hospital Readmissions

Please add 2 more research article summaries, your pick. They just need to be peer reviewed.  Limitations to the 4 articles ( My 2 and your 2) The Evidence based practice summary and the specific recommendations for clinical practice. I attached the directions as a PDF.  In Post Discharged Patients, How Does A Follow Up Phone Call Compared to Standard Discharge Instructions Affect Readmission? 1. Introduction to the Problem This literature review will focus on examining readmission rates of patients discharged from a hospital setting.  According to a statistic reported by the Centers for Medicare and Medicaid Services (CMS), approximately 20% of all Medicare patients return to the hospital for readmission within 30 days of discharge (Polster, 2015). Events such as these do not only place strain on the hospital from increased costs, but are also associated with poor health outcomes for the patient. The Joint Commission suggests that healthcare professionals should use a “multifaceted approach” to prevent readmissions that includes the following: explanations of discharge instructions, self-care, and ongoing or emergency care; inventory of outpatient referrals and resources, medication reconciliation, and patient individualized instructions based on their level of education and understanding (Polster, 2015). While all of these tools are effective for helping prepare patients to transition their care into the home setting, this literature review will investigate on two specific tools: Standard discharge instructions given upon leaving the hospital and follow up phone calls completed by the patients healthcare team within 48 hours of discharge.  2. PICOT Question The PICOT Question: In the population of discharged patients (P), what is the effect of a follow-up phone call (I), compared with standard discharge instructions (C) on readmission rates following patient discharge?  3. Search Strategy A comprehensive search of the following databases was conducted: Cumulative Index of Nursing  and Allied Health Literature (CINAHL), MEDLINE and the Nursing & Allied Health Database. In addition to this, Google Scholar was also utilized to search for recent, unpublished articles. The search was limited to English, full text, peer-reviewed articles published after 2013. Each article included in this review explored whether or not a follow up phone call post-discharge significantly affected readmission rates in patients who have had recent hospital stays. The 5 articles chosen were reviewed using Critical Appraisal Skills Program Qualitative Research Checklist and then were further thematically analyzed.  Keywords included: Readmission rates, Rehospitalization, Discharge education, Follow up calls, Continuance of care, Discharge information. The Search terms included were as follows: Readmission rates or rehospitalization Phone calls or telephone calls or follow up calls Discharge education This search criteria yielded a small number of results. 13 articles were returned by CINAHL Complete, 9 were returned by MEDLINE complete and 4 were returned the Nursing & Allied Health Database. In search of more options, the criteria was then changed to the following: 1. Readmission or rehospitalization 2. Phone calls or telephone calls or follow up calls 3. Discharge This search yielded 142 results, inclusion criteria and limits remained the same as the first search. Medline produced 64 articles, CINAHL produced 58 articles and the Nursing & Allied Health Database produced 20 articles. and With a larger pool of articles to chose from, specific writings could be chosen for the literature review. 4. Brief Summary of the Articles The first study chosen was a controlled and randomized clinical trial that explored the success of  a clinical program put in place to call patients within 7 days of patient discharge form an inpatient unit. In order to improve generalizability of the results, the population included in the clinical trial consisted of patients discharged form general medical floors, and did not include those discharged from subspecialties. The trial utilized both a control and experimental group. The participants in the control group did not receive a follow up call in comparison to the experimental group who were contacted within their first week home. The results of the study revealed that participants who were contacted via telephone for any follow-up needs demonstrated lower readmission rates for the next 30 days. Patients who were not called displayed not only higher rehospitilization rates, but also exhibited longer mean hospital stays as well (Yiadom et al,. 2017). 2. The second article chosen led with a purpose similar to the article discussed above. The study utilized a retrospective observational study design and catered to a sample size of 5,507 eligible participants. Participants either received or did not receive a phone call within 72 hours of discharge from the hospital setting. The results did show a correlation between lower readmission rates and patients who were called and able to be reached, however it is noted that both ethnicity, race and lower socioeconomic status all played a role in the differential impact of the follow up call when compared to white patients. This study suggests that existing call-back programs could be better improved by increasing their phone outreach while concurrently working to refine the care given to patients during the calls. (Harrison et al.,).  Limitations to this study include population -A brief summary of each of the articles and the Level of Evidence rating for each, including the evidence rating scale used (i.e. Level I, Johns Hopkins Nursing Evidence Based Practice Scale) 5. Evidence Based Practice Summary  -In-depth discussion of major findings from the literature (EBP summary). This can be organized by article or major themes 6. Specific recommendations for clinical practice Findings Conclusion

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