Dissertation
Decreasing readmission rates in acute stroke patients using a transition of care intervention
Doctor of Nursing Practice (D.N.P.), Drexel University
30 May 2023
DOI:
https://doi.org/10.17918/00001996
Abstract
Stroke patient readmissions 30 days after discharge are common across different hospital systems and associated with gaps in care post-discharge and are often preventable. An observed practice problem at a large comprehensive hospital is there is no standard of care for patients as they transition back into the community. Transition care models have been adopted by hospitals to help address the gaps in continuity of care. One method that hospitals use to address the transitions of care after discharge is the use of discharge phone calls, especially to patients discharged home. However, discharge calls are rarely made for patients discharged to subacute rehabilitation (SAR) facilities. The purpose of the project was to use a Plan-Do-Study-Act (PDSA) methodology to implement a nurse-led quality improvement using discharge phone calls SAR facility providers (physicians, nurse practitioners, physician assistants) within one to 3 days after stroke patients are discharged to identify the feasibility of competing calls and assist with the post-acute care information transfer. A secondary goal was to evaluate if the calls helped decrease ED visits and rehospitalizations in less than 30 days. The project identified that discharge calls can be successfully completed to SAR providers. The discharge calls showed they are a helpful addition to ensuring continuity of patient care after a hospital stay. However, discharge calls in addition to more time and collaboration between hospitals and SAR providers are needed to see a decrease in ED visits and readmissions. Keywords: Stroke, discharge calls, subacute rehabilitation, nursing, readmissions
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Details
- Title
- Decreasing readmission rates in acute stroke patients using a transition of care intervention
- Creators
- Shawanda M. Patterson - Drexel University, Drexel University (1970-)
- Contributors
- Barbara Ruth Osborne (DNP Chair) - Drexel University, Drexel University (1970-)Jennifer L. Cummings (Advisor) - Drexel University, Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Nursing Practice (D.N.P.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- 65 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Doctoral Nursing; Nursing (Graduate); College of Nursing and Health Professions; Drexel University
- Other Identifier
- 991021872801504721