Date of Award

10-2018

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Jochebed Bea Ade-Oshifogun

Second Advisor

Cynthia Small

Third Advisor

Eileen Willits

Abstract

Background

Readmission can cause much frustration for patients and families. The Center for Medicare and Medicaid Services (CMS) has emphasized the importance of finding ways to decrease readmissions within 30 days of discharge. In the southwest healthcare organization studied, the 30-day readmission rate for abdominal surgeries was 10%. The goal of the study was to identify the causative factors for the readmissions and make appropriate suggestive changes. This project identified the factors contributing to the 30-day readmission rate in selected abdominal surgeries between January 2016-July 2017 and developed a policy to address the predominant factor.

Method

After receiving institutional review board approval, the project author conducted a retrospective charts review. From the electronic health record (EHR) database at a southwest healthcare hospital system. 299 charts were selected. Thirty charts met the inclusion criteria and were analyzed using descriptive statistics. The FADE Model for quality improvement implemented served as the basis for practice review and changes through policy.

Results

Among all the factors examined, infection diagnosis accounted for 43% of reviewed readmissions, followed by small bowel obstruction, which accounted for 10% of readmissions, and abdominal pain which accounted for 7 %. The lack of communication with the patient about their treatment and plan of care is the most suggested cause of infection noted by the focus group. The project author developed a policy to improve the plan of care for postsurgical patients using CDC Policy process. The FADE Model helps to prioritize the process of policy development, which will improve patient care by reducing infection rates in surgical patients.

Conclusion

Postsurgical infection was the main factor contributing to 30-day readmission and a change in policy that was developed by the project manager and subsequently instituted by stakeholders has the potential of decreasing the readmission rate in the southwest healthcare hospital system.

DOI

https://dx.doi.org/10.32597/dnp/2

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