Document Type

Report

Publication Date

2019

Date of Final Presentation

3-7-2019

Committee Chair

Sara Ahten, DNP, MSN, RN, NC-BC

Committee Member

Cara Gallegos, PhD, RN

Coordinator/ Chair of DNP Program

Pamela Gehrke, EdD, RN

Abstract/ Executive Summary

Problem Description: It is estimated that approximately ~0.5%, or ~400,000, of all U.S. children, are identified as having complex chronic conditions (CCC) and account for as much as one-third, or ~$100 billion, of health care spending for all children. The goal of this quality improvement (QI) project was to identify the impact of a revised discharge process for children with Single Ventricle Heart Disease (SVHD) on hospital utilization rates and the parent’s perception of discharge readiness during the interstage period. The QI project was conducted in a 44-bed cardiac care unit within a 336-bed freestanding pediatric, academic medical center in a large urban area. The participants of the project are the parents or guardians of the children with SVHD, not the children themselves.

Interventions: The outputs of the QI project included the development of a discharge bundle, which consisted of four specific aspects; 1. Assignment of a specific outpatient nurse coordinator; 2. Revised discharge education; 3. Utilization of remote home monitoring; and 4. Completion of a telemedicine encounter within 48 hours of discharge. Data reports were developed to measure hospital utilization rates and parent’s perception of discharge readiness was measured utilizing two validated surveys, the Quality of Discharge Teaching Scale and the Patient Readiness for Hospital Discharge Study.

Results: This QI project was well received by all members of the clinical team as well as the parents. A total of five patients were enrolled with 100% compliance with all aspects of the discharge bundle. 36 telemedicine encounters were completed on the five patients enrolled in this project. A decrease in hospital encounters from an average of 3.75 encounters to 3.5 encounters within 30 days of discharge; a decrease of 7%. Patients in the pilot had an average direct cost per unique patient of $140,050 down from $164,088 in the pre-bundle discharge group, a decrease of 15%. There was no statistical difference in parent’s perception of discharge readiness, however, subjective data gathered from families was extremely positive.

Interpretation: Implementing new IT solutions at any organization is often time-consuming and challenging; this was no different for this QI project. Although the implementation of the home monitoring portion of this project took longer than expected, the outcome was a comprehensive, well-configured system that has provided a framework by which LCH could follow when future initiatives are identified

Conclusion: This project demonstrated the benefits and considerations that exist when implementing a revised discharge process for SVHD patients during the interstage period. Benefits came in the form of the telemedicine encounter and the ability of the nurse coordinator to address and visualize concerns related to feeding, breathing, and socialization. The acceptance of this QI project by all members of the clinical team and families suggest the need for a longitudinal review of the impact of this initiative.

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