Quality Improvement Proposal Assignment

Quality Improvement Proposal

Overview of Readmissions and the Need for Quality Improvement

According to Psotka et al. (2020 Quality Improvement Proposal Assignment), almost twenty percent of hospitalized patients become readmitted within thirty days of discharge. The majority of these readmissions are usually unplanned and result from clinical deterioration of the discharged patients. These readmissions can be attributed to poor continuity of care, especially for chronically ill patients. Half of the readmitted patients are reported not to have seen a physician before readmission.

Quality Improvement Proposal Assignment

However, lack of physician visits has not been directly implicated in the readmission of patients. Less than 20% of discharges are followed by an adverse drug reaction or event, usually avoidable. According to the New England Journal of Medicine, the leading contributors of readmission in the USA include heart attack, pneumonia, congestive heart failure, COPD, and hip or knee replacement (Psotka et al., 2020 Quality Improvement Proposal Assignment).

Approximately 75 percent of these readmissions are usually preventable whenever necessary precautions are observed. Even though readmissions appear to have a direct detrimental impact on patients, the rising frequency of re-hospitalizations has a negative impact on hospitals as well (Psotka et al., 2020). Additionally, re-hospitalization greatly influences your practice and the entire US healthcare system. Hospitals or health centers associated with increased cases of readmission of patients are usually affected financially and reputationally (Joynt Maddox et al., 2019 Quality Improvement Proposal Assignment).

Quality Improvement Proposal Assignment

Notably, all readmissions in a healthcare facility are usually reported to the Centers for Medicare and Medicaid Services (CMS). Hospitals or healthcare centers experience additional costs as they are not compensated for the care they provide for readmitted individuals. Additionally, hospitals face penalties of up to 3 percent of the hospital’s total Medicare reimbursement whenever their readmissions exceed the expected annual readmissions (Joynt Maddox et al., 2019).

Re-hospitalization has been found to have an adverse impact on the patient, including emotional, psychological, and physiological effects (Park et al., 2019). Therefore, these negative impacts necessitate the need for a reduction in readmissions. The significance of this is to reduce the effects on the patient and the financial and reputation impact on the related hospital and healthcare system. Consequently, does the improved discharge process reduce the rate of readmissions? Quality Improvement Proposal Assignment

Improving the Discharge Process to Reduce Readmissions

According to Prusaczyk et al. (2019), improving the admission and discharge process plays a leading role in reducing readmissions. Furthermore, coordination and communication among interprofessional team members both inside and outside the hospital and between patients and their caregivers are critical in reducing readmissions. Improved discharge necessitates understanding the characteristics that lead to the admission of the patient and focusing on the whole picture of the patient, including the causative factors of their condition and how to mitigate them, associated medical conditions, correct prescription of drugs, proper follow-ups, home care, and possible remission of the current health concern (Prusaczyk et al., 2019 Quality Improvement Proposal Assignment).

Poor transfer of patient information to patient information has also been associated with increased cases of readmission (Agrawal et al., 2018). Quality discharge of the patient includes the accurate transfer of data. This includes information on how to use the prescribed medication after discharge. Additionally, education on warning signs that warrant an emergency call to their physician is necessary to avoid worsening of their condition that may warrant re-hospitalization and increased cost of care. This information should be clear and in a simple language that the patient can easily understand. Quality Improvement Proposal Assignment

Furthermore, timely post-discharge physician visits have been associated with fewer cases of re-hospitalization. A timely post-discharge physician visit ensures continuity of care for the patient, ensuring that any serious health concerns are addressed as soon as possible, preventing progression to a worse state that may necessitate re-admission (Agrawal et al., 2018 Quality Improvement Proposal Assignment).

Furthermore, improved discharge involves ensuring that a primary care physician is aware of the patient’s hospitalization. This makes it easy for the patient to have faster post-discharge visits by the primary care physician in case the patient’s condition worsens. The primary care physician also has good patient knowledge, current drug therapy, and medication reconciliation. Patients’ drug therapy can be tailored according to the severity of their condition, current drug therapy, and possible allergic reactions, thus avoiding drug therapy duplication or interaction that may have adverse effects on the patient (Heaton et al., 2019 Quality Improvement Proposal Assignment).

Lastly, as part of the improved discharge, the transition from hospital to home care is essential in avoiding cases of patient readmission. Home care can be enforced through telemedicine, telemonitoring, health mobile platforms, community nurses (home visits), and home telephone calls in our setting. Home care is necessary to ensure close monitoring of a patient’s condition, which is critical in ensuring that the patient adheres to the prescribed medication and therapies. It is also essential in clarifying information about their condition, possible exacerbation, and drug dosages in the event of earlier misunderstanding. Therefore, ensuring that a patient is connected to a health care physician or system during the transition from hospital to home care is essential to their recovery (Heaton et al., 2019 Quality Improvement Proposal Assignment).

Steps in Improving Discharge Process to Reduce Readmissions

To ensure improvement in the discharge of patients, common elements include provider coordination, patient education, self-management support, reactive intervention, and proactive intervention (Heaton et al., 2019). Synchronization of these elements ensures improvement of patient discharge. It thus prevents possible readmissions that are associated with a variety of demerits for the patient, associated hospitals, and the healthcare system at large. The following steps are critical in ensuring improved discharge. Quality Improvement Proposal Assignment

Responsibilities and roles allocation:

Within the healthcare setting, this entails interprofessional coordination. The specific delineation of tasks and duties to the available staffing in the given health care setup allows for provider coordination. Correct duty assignment ensures that patients are cared for at the best level possible at any given time. Their information is meticulously kept, their medical history and physical examinations are thorough, and their evaluation prior to discharge is thorough. This also ensures that patients are admitted and discharged on time, per their health state. Quality Improvement Proposal Assignment

Initiation of discharge process upon admission:

The patients’ recovery goals are established at the time of admission. After admission, the start of the discharge process ensures that patients are only released after achieving the established goals. As a result, patients are not discharged before reaching a stable state. This has a significant impact on the patient’s recovery and readmission owing to the recurrence of the same problem. Quality Improvement Proposal Assignment

Patient education throughout hospitalization:

Education of patients during hospitalization plays a vital role in ensuring understanding of their condition, emergency state, drug dosing, and symptoms of possible drug reaction that may warrant readmission (Cornes et al., 2018).

Timely accurate information flow:

This involves the flow of information from the primary care physician (PCP) to the hospital team and back to the PCP. This is essential in ensuring correct drug prescription, therapy indication, patient education, and non-indicated discharge (Cornes et al., 2018 Quality Improvement Proposal Assignment).

Complete patient discharge summary prior to discharge:

The discharge summary provides necessary medical information that the facility must submit to the receiving caregiver responsible for the patient’s care after discharge when the patient departs the facility. This ensures an efficient patient transition from the hospital to home or to the next point of care (Cornes et al., 2018).

Comprehensive written discharge plan is given to the patient prior to discharge:

This also serves as a guide for the patient’s treatment continuity and plays a crucial role in preventing the patient’s deteriorating and, as a result, readmission. Furthermore, this is considerably more efficient when presented in a language or format that the patient understands and reinforced with the patient after discharge (Cornes et al., 2018).

Case management outside of the limited daytime hours and at home:

Delegation of responsibilities of caring for the patient outside the hospital setting to the right individuals or community nurses and visiting physicians is necessary to ensure better patient care. Continuous quality improvement of the discharge process is essential in ensuring continuous readmission reduction (Cornes et al., 2018).

Evaluation of Quality Improvement Initiative

The effectiveness of improving the discharge process will be assessed by comparing the number of readmissions experienced within one month of implementing the discussed steps to the number of readmissions experienced in the previous month prior to implementing the suggested measures. This will be done by comparing the raw numbers. The results will then be used to test the hypothesis “improving discharge process reduces readmission cases.” In this case, independent variables are “before implementation” and “after implementation” of steps to improve the discharge process. Dependent variables will be the cases of readmissions before and after implementing the suggested measures to improve the discharge process. The most appropriate statistical test for this study is to use Fisher’s exact test, which fits for binary data in an unpaired sample, as in this case (Carrasco et al., 2020). The expected outcome is that cases of readmissions will be fewer after the implementation of the suggested steps to improve the discharge process.

Quality Improvement Proposal Assignment References

  • Agrawal, S., Garg, L., Shah, M., Agarwal, M., Patel, B., Singh, A., Garg, A., Jorde, U. P., & Kapur, N. K. (2018). Thirty-day readmissions after left ventricular assist device implantation in the United States: Insights from the Nationwide Readmissions Database: Insights from the Nationwide Readmissions Database. Circulation. Heart Failure, 11(3), e004628. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004628
  • Carrasco, J., García, S., Rueda, M. M., Das, S., & Herrera, F. (2020). Recent trends in the use of statistical tests for comparing swarm and evolutionary computing algorithms: Practical guidelines and a critical review. Swarm and Evolutionary Computation, 54(100665), 100665. https://doi.org/10.1016/j.swevo.2020.100665
  • Cornes, M., Whiteford, M., Manthorpe, J., Neale, J., Byng, R., Hewett, N., Clark, M., Kilmister, A., Fuller, J., Aldridge, R., & Tinelli, M. (2018). Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature. Health & Social Care in the Community, 26(3), e345–e359. https://doi.org/10.1111/hsc.12474
  • Heaton, P. C., Frede, S., Kordahi, A., Lowery, L., Moorhead, B., Kirby, J., Kunze, N., & Luder, H. (2019). Improving care transitions through medication therapy management: A community partnership to reduce readmissions in multiple health-systems. Journal of the American Pharmacists Association: JAPhA, 59(3), 319–328. https://doi.org/10.1016/j.japh.2019.01.005
  • Joynt Maddox, K. E., Reidhead, M., Hu, J., Kind, A. J. H., Zaslavsky, A. M., Nagasako, E. M., & Nerenz, D. R. (2019). Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program. Health Services Research, 54(2), 327–336. https://doi.org/10.1111/1475-6773.13133
  • Park, C., Otobo, E., Ullman, J., Rogers, J., Fasihuddin, F., Garg, S., Kakkar, S., Goldstein, M., Chandrasekhar, S. V., Pinney, S., & Atreja, A. (2019). Impact on readmission reduction among heart failure patients using digital health monitoring: Feasibility and adoptability study. JMIR Medical Informatics, 7(4), e13353. https://doi.org/10.2196/13353
  • Prusaczyk, B., Kripalani, S., & Dhand, A. (2019). Networks of hospital discharge planning teams and readmissions. Journal of Interprofessional Care, 33(1), 85–92. https://doi.org/10.1080/13561820.2018.1515193
  • Psotka, M. A., Fonarow, G. C., Allen, L. A., Joynt Maddox, K. E., Fiuzat, M., Heidenreich, P., Hernandez, A. F., Konstam, M. A., Yancy, C. W., & O’Connor, C. M. (2020). The Hospital Readmissions Reduction Program: Nationwide perspectives and recommendations: A JACC: Heart failure position paper. JACC. Heart Failure, 8(1), 1–11. https://doi.org/10.1016/j.jchf.2019.07.012

Quality Improvement Proposal Assignment Instructions

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply \”The Road to Evidence-Based Practice\” process, illustrated in Chapter 4 of your textbook, to create your proposal. Quality Improvement Proposal Assignment

Include the following:

Provide an overview of the problem and the setting in which the problem or issue occurs.
Explain why a quality improvement initiative is needed in this area and the expected outcome.
Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.

Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.

Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.

Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded. Quality Improvement Proposal Assignment

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

I was thinking to write my proposal on improving the discharge process to decrease readmissions?

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