American Journal of Nursing最新文献

A systematic approach to implementing care standards is needed.

Background: Children with medical complexity (CMC) have a high risk of readmission and encounter numerous barriers to care after hospital discharge. Several programs have attempted to mitigate these challenges, with variable impact on readmission rates and care fragmentation.

Purpose: We implemented a novel telehealth program utilizing the full scope of nursing practice to support hospital-to-home transitions and reduce readmission rates for CMC. The aim of our program was to achieve a 10% reduction in the baseline 30-day readmission rate for this population.

Methods: Eligible inpatients were those with one or more home health orders, a hospital stay of at least seven days, and a previous hospitalization/ED visit in the past year or an intensive care admission during the current hospitalization. The intervention consisted of a virtual nurse visit three to seven days after discharge, with additional follow-up as needed, and handoff to the outpatient team within 30 days to reduce care fragmentation. Our primary outcome was 30-day readmission rates compared to the historical baseline for similar patients. Secondary outcomes included the identification and resolution of care barriers and 30-day ED revisit rates.

Results: From January 2020 to June 2024, 974 patients were enrolled in the program, and nurses completed 1,377 telehealth encounters. The 30-day readmission rate decreased from 17.6% to 10.1% over four years. We identified care barriers in 51% of encounters, primarily related to scheduling follow-up appointments (28.5%) and obtaining medical supplies (21.1%). The 30-day ED revisit rate declined from the preintervention baseline of 12.4% to 10.3%.

Conclusions: By utilizing nurses working at the top of their license, readmission rates were reduced for a diverse, high-risk patient population. Novel features of the program included minimal exclusion criteria; bridging inpatient and outpatient care teams; and the ability to address clinical questions, care coordination, and social determinants of health needs through a single point of contact. Successful implementation at a second hospital suggests that the model to reduce readmission rates in complex patients could be replicated elsewhere.

Editor's note: This is the 30th article in a series on clinical research by nurses coordinated by the Heilbrunn Family Center for Research Nursing at Rockefeller University. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation-and most can be read without knowledge of the preceding articles. To see all the articles in the series, go to https://links.lww.com/AJN/A204.

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Abstract: People undergoing ostomy surgery face an extended physiologic and psychosocial recovery. It is not uncommon to experience interruptions in work, pursuing life goals, relationships, physical activity, and social life. Even those with previous travel experience may feel inhibited by their new ostomy. Nurses, including those experienced in wound and ostomy continence, provide essential care to patients recovering from surgery and adjusting to their stoma. With counseling, education, and experience, patients can develop increasing competence and autonomy. This, in turn, helps an ostomate look forward to social activities-including traveling. However, there may be concerns related to stoma management; worry about packing essential appliances; and fear of leaking, odor, and embarrassment from loud stoma noises. This article provides focused information and resources to guide nurses in preparing people living with stomas for safe and enjoyable travel within the parameters of their special health condition and needs.