Date of Conferral

2021

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Joanne Minnick

Abstract

Hospital readmissions are a reflection of poor quality of care. The readmission rate in an acute care for the elderly (ACE) unit was above the national benchmark in 2017. The specific problem includes lack of communication, collaboration, and coordination among the interdisciplinary team. Further, in older adults, the problem is accentuated by health illiteracy, comorbidities, cognitive impairment, polypharmacy, and unclear discharge and follow-up care instructions. Poor care transition costs Medicare 17.4 billion dollars a year. Multidisciplinary rounds (MDRs) have been adopted by many hospitals as evidence-based interventions to reduce readmissions within 30 days. This Doctor of Nursing Practice (DNP) project was an evaluation of a quality improvement (QI) initiative, and sought to evaluate whether MDRs as evidence-based practice would demonstrate a reduction in readmissions in the ACE unit. The MDRs were implemented as the intervention from October 2018 to May 2019. The practice-focused question for this DNP project was: if the use of MDRs as QI initiative in an ACE unit would demonstrate a reduction in readmissions during the implementation. The aggregate readmissions data for 9 months before, during, and after implementation were accessed retrospectively to compare the means of pre-, during, and post-MDR performance using paired-samples t test. Although 5 out of 9 months the readmissions were below the mean during preimplementation, there was no statistical significance. Recommendations were made to repeat the pilot study for at least a year having structure and process guidelines for participation in MDRs. This problem affects quality of life, and this capstone project aimed to bring about a social change by reducing readmissions in vulnerable older adults.

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