DISCUSSION POST # 2 Reply to Nozomi

My PICOT question will seek to explore the effect of a nurse-led post-discharge heart failure (HF) clinic on the 30-day readmission rates and quality of life (QOL) for patients who are hospitalized for HF. According to Savarese et al. (2019), outpatient HF educational programs provided to patients after discharge significantly improves the 30-day readmission rates for this condition. In order to implement this intervention, the patients should be instructed on the post-discharge education pathway prior to discharge (Savarese et al., 2019). For instance, as a part of the discharge instruction, the patients should be informed that they should expect a phone call from the hospital case manager within 7 days to begin the process of being enrolled in the post-discharge HF clinic (Savarese et al., 2019). This initial phone call is crucial, because it will include the specific expectations and timeline of the clinic education. Once the patient and his or her caregiver express agreement and understanding of the plan, then he or she will be enrolled in the educational program.

            This nurse-led clinic will utilize a patient-centered approach and teach-back techniques, and it will emphasize the importance of self-care and self-management of HF (Talevski et al., 2020). The teach-back method allows the patient an opportunity to confirm their understanding of the educational topic with their healthcare provider (Talevski et al., 2020). This will allow both the provider and the patient to identify any misunderstanding and knowledge deficits, which will increase the likelihood of patient adherence to treatment (Talevski et al., 2020). Additionally, a stronger understanding of the topic will lead to an improvement in the ability for patients and caregivers to manage HF at home, which makes the program more sustainable (Talevski et al., 2020). Furthermore, an impaired QOL is associated with an increased risk for hospital readmissions for patients with HF (Al- Tamimi et al., 2021). Thus, the patients’ perception of QOL, as measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), will be measured before and after the intervention (Kularatna et al., 2020). This will demonstrate both the subjective and objective measures for the effectiveness of the education program.  

Challenges and Proposed Solutions

            There are numerous challenges to the implementation of this program. Two of the major obstacles are the complexity and the chronic nature of HF, as well as patient lack of knowledge regarding the disease (Sevilla-Cazes et al., 2018). HF is a complex disease that requires numerous lifestyle changes, such as diet modification, fluid restriction, medication compliance, and daily weight monitoring (Sevilla-Cazes et al., 2018). This can be overcome through the teach-back style of the intervention, as well by measuring the patients’ perception of the effectiveness of the intervention using the MLHFQ (Kalaratna et al., 2020). By ensuring that the patients and caregivers have a thorough understanding of the disease process and the treatment plan, they are less likely to be readmitted for exacerbations.

            Another challenge for patients is the lack of support systems and transportation methods, especially for those who live in remote locations (Nagarandeh et al., 2021). Even if the patients are enrolled in the HF clinic, they are unlikely to present to the clinic if they lack the ability to travel to the location. This is especially true for patients who also suffer from lack of social support and isolation (Nagarandeh et al., 2021). A possible solution to this issue is the utilization of telehealth services, in which the patients are able to participate in the HF class remotely (Koser et al., 2-18). Although this will require additional network requirements and education, it will be a practical solution to those who cannot present to the clinic in person.

            Another major challenge to the implementation is the cost incurred by the hospital or a healthcare organization due to the nurse-led clinic. However, it is important to remember that there is a high cost associated with readmissions of patients with HF. For instance, Hospital Readmissions Reduction Program (HRRP), which is part of the Affordable Care Act (ACA), penalizes hospitals for high readmission rates of Medicare patients HF (Warchol et al., 2019). Additionally, the Hospital Value-Based Purchasing program links care quality to financial reimbursement that hospitals receive (Warchol et al., 2019). These are strong incentives for hospitals to reduce readmissions through the implementation of a program to reduce HF readmissions.

            These are but a few examples of how certain challenges for the implementation may be overcome. HF is a complex disease that often requires lifelong pharmacological and lifestyle interventions. Thus, various financial and socioeconomic factors play a part in the prevention of readmission for patients with HF. Although it is a complex disease, an extensive post-discharge education may decrease the number of readmissions due to HF.