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应对降低心力衰竭 30 天再入院率的挑战:从循证实践中吸取的经验教训。

Confronting Challenges in Reducing Heart Failure 30-Day Readmissions: Lessons Learned With Implications for Evidence-Based Practice.

机构信息

Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.

Clinical Investigation Facility, David Grant USAF Medical Center, Travis AFB,Fairfield, CA, USA.

出版信息

Worldviews Evid Based Nurs. 2019 Feb;16(1):43-50. doi: 10.1111/wvn.12336. Epub 2018 Dec 5.

Abstract

BACKGROUND

Heart failure (HF) is considered a condition in which a portion of hospital admissions are preventable if timely and appropriate outpatient care management occurs. Facility readmission rates for HF are reportable and subject to penalty. Both military and civilian healthcare systems have fiscal responsibility and are accountable for successful disease management. Therefore, best practices and evidence-based strategies to reduce readmissions are in critical demand. However, translating best evidence into practice can be challenging due to the complexities of the healthcare system.

AIMS

This crosswalk paper provides strategies and considerations for nurses planning HF readmission reduction initiatives.

METHODS

Insight regarding implementation strategies, challenges, successes, and lessons learned is shared through a framework-guided description of two separate but similar HF readmission reduction projects conducted in military and civilian healthcare facilities.

RESULTS

Lessons learned suggest defined and attainable outcomes, multidisciplinary inclusivity, redundancy in roles, greater collaboration, and engagement with stakeholders are most beneficial when initiated before dedicating resources and continuously throughout practice change implementation, maintenance, and sustainment.

LINKING EVIDENCE TO ACTION

The authors advocate for interdisciplinary evidence-based practice consortiums to share lessons learned that may promote success potential and optimize return on invested time and efforts in the same or similar initiatives-in this instance, reducing 30-day readmissions for HF patients.

摘要

背景

心力衰竭(HF)被认为是一种可以通过及时和适当的门诊护理管理来预防部分住院的疾病。HF 的医疗机构再入院率是可报告的,并可能受到处罚。军事和民用医疗保健系统都有财政责任,并对成功的疾病管理负责。因此,对于减少再入院的最佳实践和基于证据的策略有迫切的需求。然而,由于医疗保健系统的复杂性,将最佳证据转化为实践可能具有挑战性。

目的

本文提供了计划心力衰竭再入院减少计划的护士的策略和考虑因素。

方法

通过框架指导的描述,分享了实施策略、挑战、成功和经验教训方面的见解,这两个独立但相似的心力衰竭再入院减少项目分别在军事和民用医疗机构中进行。

结果

经验教训表明,在投入资源之前以及在实践变更实施、维护和维持过程中,明确和可实现的结果、多学科包容性、角色冗余、更多的协作以及与利益相关者的参与,对于发起和优化投资时间和精力的回报,在相同或类似的计划中(在这种情况下,减少 HF 患者的 30 天再入院率)是最有益的。

循证实践

作者主张建立跨学科的循证实践联盟,分享经验教训,这可能有助于提高潜在成功率,并优化在相同或类似计划(在此情况下为减少 HF 患者的 30 天再入院率)中的投资时间和精力的回报。

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本文引用的文献

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The Prevention of Hospital Readmissions in Heart Failure.心力衰竭患者再入院的预防
Prog Cardiovasc Dis. 2016 Jan-Feb;58(4):379-85. doi: 10.1016/j.pcad.2015.09.004. Epub 2015 Oct 21.
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Preventing early readmissions.预防早期再入院。
JAMA. 2014 Oct 1;312(13):1344-5. doi: 10.1001/jama.2014.9473.

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