NR 706 Week 6 Practice Problem Analysis PowerPoint
Student Name
Chamberlain University
NR-706: Healthcare Informatics & Information Systems
Prof. Name
Date
PICOT Question
Does frequent rounding and close monitoring of newly admitted patients to post-acute care setting as compared to current guideline recommendations decrease hospital readmission rate over a period of 8 weeks?
The PICOT framework helps define clinical problems and guide evidence-based solutions:
| Element | Description |
|---|---|
| P (Population) | Older patients in post-acute care |
| I (Intervention) | Frequent rounding and clinicians’ encounters/assessments |
| C (Comparison) | Current practice guidelines |
| O (Outcome) | Reduced hospital readmission rates |
| T (Timeframe) | 8-week period |
This structured approach allows clinicians to evaluate whether closer observation and proactive interventions can decrease avoidable rehospitalizations.
Post-Acute Rehospitalization Rate Reduction
Hospital readmission rates among post-acute care patients remain a significant issue, with substantial clinical and financial consequences. Studies estimate that all-cause rehospitalizations cost approximately $40 billion annually, and between 5–79% of these readmissions are preventable (Harris et al., 2018). Even a modest 10% reduction could translate into savings of over $1 billion each year.
Beyond financial costs, frequent readmissions raise infection risks, extend recovery times, and diminish quality of life. Patients often suffer from prolonged pain, loss of independence, deconditioning, and reduced productivity, making preventive measures crucial (Harris et al., 2018).
Restated PICOT Application
Does frequent rounding and oversight by clinicians reduce hospital readmission rates compared to current practice guidelines over an 8-week period for newly discharged patients to post-acute care?
Key strategies include:
- Thorough assessments and close monitoring by clinicians and nurses.
- Proactive identification of early complications.
- Comparison of frequent rounding versus current guideline-based monitoring.
- Measurement of readmission rates across an 8-week post-discharge timeframe (March & Mennella, 2018).
Discharge to Community–Post-Acute Care (DTC-PAC) Measures
To better evaluate outcomes, the Centers for Medicare & Medicaid Services (CMS, 2019) introduced measures addressing rehospitalization rates post-discharge. These include:
| Measure | Key Focus |
|---|---|
| Unplanned rehospitalization (31 days) | Identifying unnecessary readmissions within a month of discharge. |
| Medical necessity vs. 30-day rounding | Evaluating whether monthly rounding is adequate compared to frequent monitoring. |
| National average rehospitalization (27%) | Establishing baseline benchmarks. |
| Patient-centered care | Encouraging individualized treatment approaches. |
| Insurance coverage inclusion | Ensuring equitable care access across patient groups. |
These measures emphasize balancing cost-effectiveness with patient safety and well-being.
Hospital Readmission Reduction Program (HRRP)
The HRRP identifies six major conditions and procedures for 30-day readmission risk standardization (Hatipoğlu et al., 2018):
- Acute Myocardial Infarction (AMI)
- Congestive Heart Failure (CHF)
- Pneumonia
- Coronary Artery Bypass Graft (CABG)
- Chronic Obstructive Pulmonary Disease (COPD)
- Elective total hip or knee arthroplasty
By focusing on these conditions, the HRRP aligns financial incentives with improved patient outcomes, aiming to lower unnecessary hospital returns.
A New Approach: Meaningful Outcomes
Reducing rehospitalizations requires a patient-centered, collaborative model that:
- Empowers both patients and clinicians to make evidence-based health decisions.
- Enhances state and local flexibility to deliver quality care.
- Encourages innovative solutions that improve affordability, accessibility, and quality of care.
- Prioritizes prevention and early intervention to decrease costly complications.
NR 706 Week 6 Practice Problem Analysis PowerPoint
Failure Modes & Effects Analysis (FMEA)
FMEA identifies potential risks contributing to readmissions.
| Failure Mode | Failure Cause | Potential Effect |
|---|---|---|
| Missed handoff reports | Missed care opportunities | Delayed treatment |
| Delayed assessment post-admission | Provider unaware of admissions | Higher hospitalization risk |
| Low rounding frequency | Delayed recognition of complications | Increased readmission rates |
Such risks highlight the importance of structured communication and consistent provider presence (Harris et al., 2018).
Ishikawa (Fishbone) Diagram Factors
Contributors to higher readmission rates in post-acute care include (LUCA, 2016; March & Mennella, 2018):
- Medical doctors and ARNPs – variability in follow-up care.
- Skilled nursing facilities – inconsistencies in clinical rounding.
- Electronic health records (EMR) – systems like PointClickCare and Gherimed sometimes contribute to missed care opportunities.
- Monitoring gaps – inadequate assessments leading to delayed interventions.
Conclusion
Frequent provider rounding, thorough assessments, and closer patient monitoring have the potential to:
- Identify decompensation earlier and allow timely interventions.
- Reduce avoidable hospital readmissions.
- Improve overall quality of care and patient life outcomes.
- Shorten rehabilitation times and enable earlier discharges home.
Evidence supports that proactive post-acute monitoring is a cost-effective, patient-centered strategy that benefits both individuals and healthcare systems (UpToDate, 2019; Agarwal & Werner, 2018).
References
UpToDate. (2019). Hospital discharge and readmission. https://www.uptodate.com/contents/hospital-discharge-and-readmission
Agarwal, D., & Werner, R. M. (2018). Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending. Health Services Research, 53(6), 5035–5056. https://doi.org/10.1111/1475-6773.13023
Center for Medicare & Medicaid Services. (2019). Skilled Nursing Facility 30-Day Potential Preventable Readmission Measure (SNFPPR). https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2801
Harris, C., Garrubba, M., Melder, A., Voutier, C., Waller, C., King, R., & Ramsey, W. (2018). Sustainability in health care by allocating resources effectively (SHARE) 8: Developing, implementing and evaluating an evidence dissemination service in a local healthcare setting. BMC Health Services Research, 18(1), 151.
Hatipoğlu, U., Wells, B. J., Chagin, K., Joshi, D., Milinovich, A., & Rothberg, M. B. (2018). Predicting 30-day all-cause readmission risk for subjects admitted with pneumonia at the point of care. Respiratory Care, 63(1), 43–49. https://doi.org/10.4187/respcare.05719
NR 706 Week 6 Practice Problem Analysis PowerPoint
LUCA, L. (2016). A study on quality analysis measuring process. Fiability & Durability, 2, 68–72.
March, P. P., & Mennella, H. D. A.-B. (2018). Quality improvement in long-term care. CINAHL Nursing Guide.