Evidence-based Individualized Discharge Educational Intervention for Coronary Artery Disease (CAD) patients; A Benchmark Project

Coronary artery disease (CAD) is the leading cause of death worldwide, whereas, in the United States, 16,800,000 people are affected, resulting in 450,000 deaths annually. Patients’ perceptions of self-management related to treatment adherence, lifestyle modifications, and risk-factor management are significant indicators of outcomes following a cardiac event. To promote self-management in CAD patients, this benchmark project aims to determine the impact of individualized education interventions by establishing a standardized nurse-led educational intervention in the cardiac unit that emphasizes adherence to self-management and treatment regimen to improve quality of life and prevent rehospitalization due to worsening cardiac events. The evidence-based findings in the studies are supported by the evidence from systematic reviews of RCTs, evidence from systemic reviews of qualitative studies, and the evidence obtained from well-designed RCTs. The databases searched included the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed. The search was limited using the evidence-based practice key, systematic review, and meta-analysis. There are multiple patient education delivery methods to meet the needs of patients. However, evidence from research interventions has been synthesized with the recommendations of individualized nurse-led discharge educational intervention for patients with CAD to improve their outcomes, promote quality of life, as well as reduce the readmission rate of hospitals

Developing a Total Knee Care Pathway to Reduce Hospital Length of Stay While Maintaining Quality of Care

From 2002 to 2013, there was an increase in the number of total joint replacement procedures performed as well as a rise in healthcare costs associated with such procedures. The Affordable Care Act of 2012 leveraged a shift in Medicare reimbursement from a fee-for-model (a payment model where services are paid separately) to a bundled payment method linked to quality of care. Joint replacement surgeries, specifically total knee arthroplasties (TKA), are one of the largest procedural expenditures for Medicare. To reduce costs, care associated with a TKA procedure was bundled to include all aspects of the procedure including post-operative supportive cares. Care pathways have been highly researched across the country as an effective method to reduce healthcare cost without comprising the quality of care. The goal of care pathways is to provide a seamless, structured care process that enhances decreased length of hospital stay, thus decreasing cost, while still maintaining an excellent quality of care. Unfortunately, there is no standard care pathway for a TKA , although medical institutions may develop their own care pathway based on the requirements of Medicare reimbursement and their quality of care standards. The purpose of this scholarly inquiry paper assess for modalities of treatment for a clinical care pathway. Current literature supports the use of care pathways with a focus on structure, process and outcomes of total knee arthroplasty with the intent on reducing cost of care. Future recommendations based on the evidence supports the implementation of standardized care pathways that focuses on preoperative, intraoperative, and postoperative care for TKA procedures that meet a national standard, while maintaining quality care and taking into account the needs of each individual institution

Fast-tracking for total knee replacement reduces use of institutional care without compromising quality

Background and purpose — Fast-tracking shortens the length of the primary treatment period (length of stay, LOS) after total knee replacement (TKR). We evaluated the influence of the fast-track concept on the length of uninterrupted institutional care (LUIC) and other outcomes after TKR. Patients and methods — 4,256 TKRs performed in 4 hospitals between 2009–2010 and 2012–2013 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified as fast track (Hospital A) and non-fast track (Hospitals B, C and D). We analyzed length of uninterrupted institutional care (LUIC), LOS, discharge destination, readmission, revision, manipulation under anesthesia (MUA) and mortality rate in each hospital. We compared these outcomes for TKRs performed in Hospital A before and after fast-track implementation and we also compared Hospital A outcomes with the corresponding outcomes for the other 3 hospitals. Results — After fast-track implementation, median LOS in Hospital A fell from 5 to 3 days (p < 0.001) and (median) LUIC from 7 to 3 (p < 0.001) days. These reductions in LOS and LUIC were accompanied by an increase in the discharge rate to home (p = 0.01). Fast-tracking in Hospital A led to no increase in 14- and 42-day readmissions, MUA, revision or mortality compared with the rates before fast-tracking, or with those in the other hospitals. Of the 4 hospitals, LOS and LUIC were most reduced in Hospital A. Interpretation — A fast-track protocol reduces LUIC and LOS after TKR without increasing readmission, complication or revision rates.Peer reviewe