Giscombe Susan R, Baptiste Diana-Lyn, Koirala Binu, Asano Reiko, Commodore-Mensah Yvonne
Department of Nursing, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA.
Contemp Nurse. 2021 Feb-Apr;57(1-2):39-50. doi: 10.1080/10376178.2021.1919161. Epub 2021 May 5.
Heart failure is a chronic, progressive condition which affects over six million Americans and 26 million people worldwide. Evidence-based guidelines, protocols, and decision-support tools are available to enhance the quality of care delivery but are not implemented consistently.
To examine the effect of clinical decision-making support during patient discharge on 30-day hospital readmission among patients admitted with heart failure and evaluate provider utilization and satisfaction of clinical decision support tool.
A quasi-experimental study.
An intervention group of hospitalized patients ( = 55) with heart failure were provided the intervention over a 3-month period and compared to the pre-intervention comparison group ( = 109) of patients who did not receive the intervention. An evidence-based discharge checklist and a pocket guide was implemented by an advanced practice nurse to assist health providers with clinical decision making. Descriptive statistics among samples, 30-day readmission rates, and provider utilization and satisfaction were examined.
Readmission rates slightly decreased ( = 109, 9.2% vs. = 55, 9.1%) in the post-intervention period, but no significant difference. Heterogeneity between the two groups were minimal related to use of specific medications, age, length-of-stay and comorbidities. Descriptively, there was a significant difference the use of diuretics among each group ( = .002).The discharge checklist was used regularly by 67% of ( = 15) providers, and 93% expressed satisfaction with use.
There was no significant reduction in 30-day readmission rates between both groups. However, a slight reduction was noted which indicates the need for further examination into how the use of checklists for clinical decision support can reduce readmissions. A well-designed evidence-based discharge plan remains a critical component of the patient discharge process. Advance practice nurses are uniquely qualified to implement evidence-based interventions that promote practice change among health care providers and improve health outcomes.
心力衰竭是一种慢性进行性疾病，影响着超过600万美国人以及全球2600万人。有基于证据的指南、方案和决策支持工具可用于提高护理质量，但并未得到一致实施。
研究患者出院时临床决策支持对因心力衰竭入院患者30天再入院率的影响，并评估医疗服务提供者对临床决策支持工具的使用情况和满意度。
一项准实验研究。
在3个月的时间里，为55名因心力衰竭住院的患者组成的干预组提供干预措施，并与未接受干预的109名患者组成的干预前对照组进行比较。一名高级执业护士实施了基于证据的出院检查表和袖珍指南，以协助医疗服务提供者进行临床决策。对样本、30天再入院率以及医疗服务提供者的使用情况和满意度进行了描述性统计分析。
干预后再入院率略有下降（109例，9.2%对55例，9.1%），但无显著差异。两组之间在使用特定药物、年龄、住院时间和合并症方面的异质性极小。从描述性分析来看，每组之间利尿剂的使用存在显著差异（P = 0.002）。67%（15名）的医疗服务提供者经常使用出院检查表，93%的人对其使用表示满意。
两组之间30天再入院率没有显著降低。然而，注意到有轻微下降，这表明需要进一步研究如何使用临床决策支持检查表来降低再入院率。精心设计的基于证据的出院计划仍然是患者出院过程的关键组成部分。高级执业护士具有独特的资质来实施基于证据的干预措施，以促进医疗服务提供者的实践改变并改善健康结局。
