Date of Conferral

2018

Degree

Doctor of Nursing Practice (DNP)

School

Health Services

Advisor

Catherine Garner

Abstract

Each year in the United States, thousands of people are readmitted within 30 days of being discharged from a hospital. Current research indicates that at least one-third of these rehospitalizations are preventable. The purpose of this project was to examine patient and environmental characteristics of those who were readmitted within 30 days of discharge for commonalities that may explain the gap in practice for a specific health care organization. The project was undertaken in response to the organization's need to improve a 50th-percentile ranking with the goal of reaching the top 10th percentile. A plan-do study-act framework was used as a guide to ensure no steps in the process were missed and the logical progression of the project was clear. Three fiscal quarters of data, including 515 readmissions, were examined. A data analytics cube on hospital-wide readmissions provided patient and environmental characteristics that were charted using common language for sorting purposes. Data analysis revealed that 77% of patients were admitted within 30 days of discharge with a diagnosis that differed significantly from the index admission. Potential gaps in practice identified were a need for more patient and family engagement and education by nursing during the inpatient stay in regard to the primary admitting condition, the management of comorbidities, and potential posthospital complications. Need exists for more intense whole-patient monitoring, communication, and education following the transition from hospital to home. A reduction in 30-day readmissions can reduce the psychological and physical burden on patients and families, on health care resources that could be used for other purposes, and on society in the form of financial costs that continue to rise.

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