High 30 Day Readmission Rates: A Case Study

High 30-day readmission rates have become problematic for many facilities. The Centers for Medicare & Medicaid Services (CMS) have put emphasis on readmission rate reductions for hospitals (“Readmissions Reduction Program”, n.d.). The stress of high readmission rates weighs heavy on facilities as a result of the Affordable Care Act (ACA) which requires CMS to reduce payments to hospitals with excess admissions (“Readmissions Reduction Program”, n.d.). Incorporating Project Re-Engineered Discharge (RED) as part of the discharge process at a small hospital will impact the facility’s readmission rates. Utilizing an evidence based practice (EBP) model can assist advance practice nurses (APN) in creating a system change. A synthesis of evidence
The new CMS guidelines from ACA reduces the payment hospitals receive causing an exorbitant amount of hospital cost left unpaid. With the cost of hospitalization left unpaid, locating a program that can impact 30-day readmission rates is of primary concern for facilities. Project RED is a nationally accepted best practice targeted on providing a customized hospital discharge plan demonstrated to reduce all-cause 30-day readmissions (Mitchell et al., 2016). Project RED originally funded by the Agency for Healthcare Research and Quality (AHRQ) has decreased readmission rates by 30% at several facilities (Stubenrauch, 2015). The target facility is not using Project RED as part of their discharge and has higher readmission rates than the facility’s leadership is comfortable with (personal communication, R. Smith, safety officer, February 28, 2017). Project RED, at a minimum, will address two of the six Institute of Medicine (IOM) domains of health care which are patient-centered and efficient (“The Six Domains”, n.d.). Adding Project RED to the current discharge process has the potential to decrease the current 30-day readmission rates at the facility providing efficient cost effective care and patient-centered
There are five star points in the ACE model, discovery, evidence summary, translation, integration, and evaluation (Bondmass, 2014). Discovery is the primary research studies search and evidence summary is the synthesis of the primary research like in a systematic review (Stevens, 2013). Translation is forming the data into a guideline that in the next step, integration, can be positioned into practice (Stevens, 2013). Once integration takes place, evaluation of the outcomes of the EBP process can take place (Bondmass, 2014). The ACE star model fits the quality improvement (QI) initiative because it offers the user the ability to discover the problems, use evidence from the literature, translate the evidence obtained and integrate it into a useful process in reducing 30-day readmission rates. Utilizing the ACE star EBP model, APNs have the ability to evaluate the QI impact through several viewpoints, how the process impacted the nursing care of patients, as well as the financial impact for the organization (Appendix