The use of clinical decision support in reducing readmissions for patients with heart failure: a quasi-experimental study.

Abstract

Background: 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.

Aims: 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.

Design: A quasi-experimental study.

Methods: An intervention group of hospitalized patients (N = 55) with heart failure were provided the intervention over a 3-month period and compared to the pre-intervention comparison group (N = 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.

Results: Readmission rates slightly decreased (N = 109, 9.2% vs. N = 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 (p = .002).The discharge checklist was used regularly by 67% of (N = 15) providers, and 93% expressed satisfaction with use.

Conclusion: 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.