Care Transitions: Are Healthcare Organizations Meeting the Needs of Their Patients?
Review TypeNone: Degree-based Submission
Review StatusNot Applicable (See Review Type)
Repository Posting Date2017-09-12T19:29:43Z
TypeDNP Capstone Project
Level of EvidenceOther
Research ApproachTranslational Research/Evidence-based Practice
CINAHL HeadingsTransitional Care; Patient Satisfaction; Telenursing; After Care; After Care--Evaluation; Outcome Assessment; Quality Improvement; Readmission; Readmission--Statistics and Numerical Data; Readmission--Evaluation
Acute care healthcare organizations struggle to identify and implement interventions to support the transition of care between hospital and home settings. One organization piloted a quality improvement (QI) project using nurse-led post-discharge telephone consultations to determine their feasibility and effect as a transition of care intervention. The QI pilot was designed to answer the clinical question: does the receipt of nurse-led post-discharge telephone consultations improve patient satisfaction and 30-day readmission rate outcomes? The goals of the pilot were to investigate the feasibility of conducting the intervention, identify transition of care gaps, and evaluate the effect on 30-day readmissions and patient satisfaction. Prior to implementation of the pilot, patient satisfaction scores associated with care transitions ranged from 29.9-58.3%; they rose to 65.7and 65.5% 30 and 60 days respectively after the intervention was initiated. 30-day readmission rates on the pilot unit ranged from 0.1238-0.1354 in the months preceding the pilot; they fell to 0.1153 and 0.0615 30 and 60 days respectively after the intervention was initiated. The intervention uncovered opportunities to better support patients in the community, which is possibly more important than small improvements in patient satisfaction scores and readmission rates. The intervention can be an invaluable tool as acute care organizations strive to better care for people within their communities.
Degree GrantorCapella University
Date of Publication2017-09-12
NotesThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
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