Reduction of the rate of hospitalization in patients with acute coronary syndrome: An action research
Abstract
Background: Readmission of patients with Acute Coronary Syndrome (ACS) causes many problems for them and their family. This study aimed to improve the quality of care provided to patients with ACS and discover solutions to reduce the rate of readmission among them.
Materials and Method: This participatory action research study was done based on Streubert and Carpenter approach. This study included 45 participants (31 patients and 14 stakeholders) and carried out in a hospital affiliated to Isfahan University of Medical Sciences, Iran, from 2013 to 2014. Solutions with high and moderate feasibility, flexibility, and suitability were implemented in each cycle until reaching <15% readmission rate. Data were analyzed using SPSS (V.16) and running descriptive and inferential statistics.
Results: In this study, several actions were performed in each cycle such as assigning a free and 24‑h telephone line was patients to contact nurses and face‑to‑face patient’s education. Second cycle actions included active participation of all nurses in the education of patients and involvement of families in patient care. By carrying out the first action cycle, the readmission rate reached 35%, which was not favorable. By completing the second action cycle, the readmission rate reached 12%, which was desirable and significantly lower than the first cycle.
Conclusion: Discovering possible solutions with the participation of stakeholders in therapeutic settings that have feasibility, flexibility, and suitability can lead to improved care quality and reduced readmission rate in patients with ACS, especially if the families of the patients also participate in action cycles.
Keywords
Full Text:
PDFReferences
Goldman JD, Harte FM. Transition of care to prevent recurrence after acute coronary syndrome: The critical role of the primary care provider and pharmacist. Postgrad Med 2020;132:426 32.
Khalife Zadeh A, Dorri S, Shafiee S. The effect of cardiac rehabilitation on quality of life in patients with acute coronary syndrome. Iran J Nurs Midwifery Res 2015;20:588 93.
Koohi F, Salehiniya H, Mohammadian HA. Trends in mortality from cardiovascular disease in Iran from 2006 2010. Journal of Sabzevar University of Medical Sciences 2015;22:630 8.
Vahedi Mazdabadi Y, Bozorgi M, Farjadmand F, Binesh Marvasti M, Akbarzadeh T, Khanavi M, et al. Investigation of cardiovascular drugs based on the minerals in Persian medicine . J Islamic Iran Traditional Med 2019;9:309 20.
Farzin K. The cost of $ 14 billion in health insurance at two heart hospitals in Tehran. Iranian students’ news agency. Available from: https://bit.ly/2Ql60V8. [Last accessed on 2019 May 29].
Dorri S, Khalifezadeh Esfahani A, Dorri Sedeh M. Effect of cardiac rehabilitation on physical and mental health components: A randomized controlled clinical trial. Sci J Kurdistan Univ Med Sci 2016;21:8 19.
Moryś JM, Bellwon J, Höfer S, Rynkiewicz A, Gruchała M. Quality of life in patients with coronary heart disease after myocardial infarction and with ischemic heart failure. Arch Med Sci 2016;12:326 33.
Rizzo E. 6 Stats on the Cost of Readmission for CMS Tracked Conditions. Becker’s Healthcare. Available from: http:// wwwbeckershospitalreviewcom/quality/6 stats on the cost of r eadmission for cms tracked conditionshtml. [Last accessed on 2016 Aug].
Cowper PA, Knight JD, Davidson Ray L, Peterson ED, Wang TY, Mark DB, et al. Acute and 1 year hospitalization costs for acute myocardial infarction treated with percutaneous coronary intervention: Results from the translate ACS registry. J Am Heart Assoc 2019;8:e011322. doi: 10.1161/JAHA.118.011322.
Varwani MH. Outcomes in patients with acute coronary syndromes at The Aga Khan University Hospital, Nairobi. 2016.
Baky V, Moran D, Warwick T, George A, Williams T, McWilliams E, et al. Obtaining a follow up appointment before discharge protects against readmission for patients with acute coronary syndrome and heart failure: A quality improvement project. Int J Cardiol 2018;257:12 5.
Hampshire AJ. What is action research and can it promote change in primary care? J Eval Clin Pract 2000;6:337 43.
Streubert SHJ, Carpenter DR. Qualitative Research in Nursing Advancing the Humanistic Imperative. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) A metadata driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377 81.
Herr K, Anderson GL. Quality criteria for action research: An ongoing conversation. In: Herr K, Anderson GL. The Action Research Dissertation: A Guide for Students and Faculty. 1st ed. Thousand Oaks: SAGE; 2005. p. 49 69.
Health research and Educational Trust Institution. Readmissions Data Collection Fact Sheet. Chicago 2016. Available from: http:// www.hret hiin.org/Resources/readmissions/17/readmissions data collection fact sheet.pdf.
Litovchik, I, Vorobeichik, D, Shlomo, N, Vered, Z, Goldenberg, I, Minha, S. P2726 Characteristics, trends and outcomes associated with 30 day readmissions following acute coronary syndrome 2000 2013: the acute coronary syndrome israeli survey (ACSIS), European Heart Journal, Volume 38, Issue suppl_1, August 2017, ehx502.P2726, doi: 10.1093/eurheartj/ehx502.P2726.
Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The care span: The importance of transitional care in achieving health reform. Health Aff (Millwood) 2011;30:746 54. doi: 10.1377/hlthaff.2011.0041.
Hwang B, Fleischmann KE, Howie Esquivel J, Stotts NA, Dracup K. Caregiving for patients with heart failure: Impact on patients’ families. Am J Crit Care 2011;20:431 41; quiz 442.
Khorasani P, Rassuli M, Nasr Esfahani M. Nurse led action research project for expanding nurses’ role in patient education in Iran: Process, structure, and outcomes. Iran J Nurs Midwifery Res 2015;20:387 97.
Chaghari M, Saffari M, Ebadi A, Ameryoun A. Empowering education: A new model for in service training of nursing staff. J Adv Med Educ Prof 2017;5:26 32.
Kahriman I, Nural N, Arslan U, Topbas M, Can G, Kasim S. The effect of empathy training on the empathic skills of nurses. Iran Red Crescent Med J 2016;18:e24847. doi: 10.5812/ircmj. 24847.
Wong P, Liamputtong P, Koch S, Rawson H. Families’ experiences of their interactions with staff in an Australian intensive care unit (ICU): A qualitative study. Intensive Crit Care Nurs 2015;31:51 63.
Tan M, Lang D. Effectiveness of nurse leader rounding and post discharge telephone calls in patient satisfaction: A systematic review. JBI Database System Rev Implement Rep 2015;13:154 76.
Lima LC, Mazzuco E, Prudêncio AL. Response to “readmission of patients with acute coronary syndrome and its determinants”: An overview of PHC. Arq Bras Cardiol 2020;114:574 5.
Falvo DR. Effective Patient Education: A Guide to Increased Adherence. Jones & Bartlett Publishers; 2010.
Farahani MA, Dorri S, Yousefi F. Design and validation of education multimedia program for patients with fecal diversions: A quality improvement project to enhance self care. J Wound Ostomy Continence Nurs 2020;47:39 44.
Thomas E, Lotfaliany M, Grace SL, Oldenburg B, Taylor CB, Hare DL, et al. Effect of cardiac rehabilitation on 24 month all cause hospital readmissions: A prospective cohort study. Eur J Cardiovasc Nurs 2019;18:234 44.
Astley CM, Chew DP, Keech W, Nicholls S, Beltrame J, Horsfall M, et al. The impact of cardiac rehabilitation and secondary prevention programs on 12 month clinical outcomes: A linked data analysis. Heart Lung Circ 2020;29:475 82.
Ghaem magham Z, Rahimian I, Najafi M, forooeddin A, Dabiri S. The comparison of group behavioral activation with and without familial support effectiveness on anxiety reduction in coronary heart disease . Journal of Research in Behavioral Sciences 2012;10: 79 89.
Refbacks
- There are currently no refbacks.