Implementing primary care follow-up for high-risk vascular surgery patients

IF 1.1 Q3 NURSING
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Abstract

Background: The Centers for Medicare and Medicaid Services consider the 30-day hospital readmission rate an outcome of care measure; a high rate is associated with high-cost and bed utilization. Purpose: The Division of Vascular Surgery at a large academic medical center implemented a 15-week quality improvement project in the fall of 2022 to reduce readmissions among patients deemed high-risk for readmission and discharged to home. Methods: The discharging provider utilized the “HOSPITAL Score for Readmission” tool to identify patients at high-risk for unplanned 30-day readmission to receive the intervention, which included follow-up with a primary care provider (PCP) within two weeks of hospital discharge to address non-surgical medical conditions that may have been exacerbated during the hospital stay. A hospital based transitional care clinic bridged medical care for identified patients without an established PCP or whose PCP could not accommodate an appointment until PCP assumption of care. Discharging providers included 11 nurse practitioners and 2 surgery residents; each received a one-on-one educational teaching session and a weekly reminder e-mail through week 9. Results: A total of 158 vascular surgery patients (low and high-risk) were discharged home over 15 weeks with 30 patients (19%) having an unplanned readmission within 30-days from discharge. Adherence issues with the intervention among staff allowed for the high-risk group to be divided into those who did not receive the intervention versus those who did. The high-risk patients who did not receive the intervention had a higher readmission rate (30.4%) than the high-risk patients who did receive the intervention (21.4%). Conclusions: Numerous acute and chronic medical problems were treated at the PCP/transitional care clinic visits, which may have contributed to the reduction in rate of readmissions occurring within 30-days for those patients. Increased usage of the transitional care clinic identified a gap that patients continue to require assistance with establishing care with a PCP and further process change in the future is needed to ensure successful transition for all patients.

对高风险血管外科患者实施初级保健随访
背景:医疗保险和医疗补助服务中心将 30 天再入院率视为衡量护理效果的指标之一;高再入院率与高成本和床位使用率有关。目的:一家大型学术医疗中心的血管外科在 2022 年秋季实施了一项为期 15 周的质量改进项目,以减少被视为再入院高风险并出院回家的患者的再入院率。方法是出院医护人员利用 "再入院HOSPITAL评分 "工具来确定30天非计划再入院的高风险患者,使其接受干预,包括在出院后两周内与初级保健医生(PCP)进行随访,以解决住院期间可能加重的非手术医疗状况。在初级保健医生承担护理工作之前,医院的过渡性护理诊所为没有固定初级保健医生或初级保健医生无法安排预约的患者提供医疗护理衔接服务。出院医护人员包括 11 名执业护士和 2 名外科住院医师;每人都接受了一对一的教育培训,并在第 9 周前每周收到一封提醒邮件。结果:共有158名血管外科患者(低风险和高风险)在15周内出院回家,其中30名患者(19%)在出院后30天内出现意外再入院。由于工作人员对干预措施的依从性问题,高风险组被分为未接受干预和接受干预的两组。未接受干预的高危患者的再入院率(30.4%)高于接受干预的高危患者(21.4%)。结论在初级保健医生/过渡性护理门诊就诊时,许多急性和慢性疾病都得到了治疗,这可能是这些患者 30 天内再入院率降低的原因之一。过渡性护理门诊使用率的提高发现了一个缺口,即患者在与初级保健医生建立护理关系时仍然需要帮助,今后需要进一步改变流程,以确保所有患者都能成功过渡。
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来源期刊
CiteScore
1.40
自引率
0.00%
发文量
33
期刊介绍: Journal of Vascular Nursing provides clinical information regarding aortic and peripheral aneurysms, upper and lower extremity arterial disease, acute and chronic venous disease, and more. Original, peer-reviewed articles present descriptions, etiologies, diagnostic procedures, medical and surgical treatment and nursing implications of vascular system disorders.
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