Outcomes of a quality improvement project implementing stroke discharge advocacy to reduce 30-day readmission rates.

The purpose of this quality improvement project was to determine whether use of aspects of a transitional care model by nurse navigators would affect 30-day readmission rates in hospitalized ischemic stroke patients discharged home with self-care. Thirty-day readmission rates and emergency department (ED) visits were compared before, during, and after the implementation of the revised discharge process. Comparative analysis demonstrated reductions in readmissions and in ED visits. Thirty-day readmission rates to our hospital decreased from 9.39% to 3.24% when comparing pre- with postintervention data. Thirty-day ED visit rates to all state hospitals decreased from 16.36% to 12.08% when comparing pre- with postintervention data.