Topic: Discuss discharge resources that are available for chronic cardiorespiratory issues to support patient independence and prevent readmission. Explain how readmission affects reimbursement. What implications does readmission have on the hospital and on the patient?

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

Example 1 (Samuel)

Ensuring that patients with chronic cardiorespiratory issues have access to resources is crucial for promoting their independence and preventing them from being readmitted to the hospital. Home health care services, which involve visits from nurses and respiratory therapists to monitor patients and help them use equipment like oxygen therapy devices and CPAP/BiPAP machines, are key resources (GCU,2022). Additionally, durable medical equipment such as nebulizers, medication management services, and telehealth for monitoring are essential in helping patients stick to their treatment plans. Rehabilitation services like pulmonary rehab, education programs, and support groups, empower patients to manage their conditions at home effectively.

Readmissions significantly impact hospital reimbursement within 30 days of discharge due to policies set by the Centers for Medicare & Medicaid Services (CMS). Through the Hospital Readmissions Reduction Program (HRRP),, hospitals with readmission rates for conditions such as heart failure and COPD may face penalties in the form of reduced Medicare payments (Centers for Medicare & Medicaid Services, 2023). These penalties encourage hospitals to focus on discharge planning and post-discharge support to lower readmission rates, ultimately aiming to enhance outcomes and decrease healthcare costs.

The consequences of readmissions on both hospitals and patients are substantial. Frequent returns to hospitals can bring about penalties, higher operational expenses, and potential harm to their standing and performance indicators. From the perspective of patients, repeated hospital visits can lead to increased health hazards, strain from medical costs, and a decline in their quality of life. The emotional strain of hospital stays may also result in feelings of anxiety and depression, making their recovery more challenging. By offering support and resources upon discharge, healthcare providers can lessen these effects, fostering improved health outcomes and boosting the overall well-being of patients (Bamforth et al., 2021).

References:

Bamforth, R. J., Chhibba, R., Ferguson, T. W., Sabourin, J., Pieroni, D., Askin, N., Tangri, N., Komenda, P., & Rigatto, C. (2021). Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis. PloS One, 16(4), e0249542. https://doi.org/10.1371/journal.pone.0249542

Centers for Medicare & Medicaid Services. (2023). Hospital Readmissions Reduction Program (HRRP). Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program

Grand Canyon University (Ed.). (2022). Pathophysiology: Clinical applications for client health(2nd ed.).

Example 2 Logan

When a patient is discharged from an acute care facility from having been treated for a cardiopulmonary disease, the transition to non acute care can be extremely difficult for some patients. After discharge, the patient will have to require more equipment, medications, or other things in order to remain healthy and not be hospitalized again (Johnson, 2022, p. 32). It is important to have the patient seen from a discharge planner or case manager before they are discharged from the acute care facility in order to help them with this transition. These resources can help the patient navigate new medical equipment set up, transportation needs, and other medically necessary devices that may be needed after discharge. Education and health promotion is necessary in order to help decrease the risk of readmission, including a healthy diet, exercise, medication adherence, and smoking cessation. Readmission’s are common with diseases related to cardiac and pulmonary disease, as many patients are at higher risk of an incident requiring hospitalization again, or they do not adhere to their treatment plan and continue to receive medical care outpatient. Readmissions can have a negative impact for hospitals, as more resources are being used during these visits. As stated by the National Library of Medicine, “…as readmissions continue to happen, a gradual increase in expenses due to greater use of resources may lead to decreased profitability” (Upadhyay et al, 2019).

References

Johnson, A. (2022). Pathophysiology: Clinical Applications for Client Health (2nd ed., p. 32). Grand Canyon University. https://bibliu.com/app/#/view/books/1000000000590/epub/Chapter1.html#page_32

Upadhyay S, Stephenson AL, Smith DG. Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospitals. Inquiry. 2019 Jan-Dec;56:46958019860386. doi: 10.1177/0046958019860386. PMID: 31282282; PMCID: PMC6614936.

Example 3 Nova

There are so many different aspects to being successful for a patient who has been diagnosed with a chronic cardiorespiratory issue. Each time these patients are re-admitted with the same issue they are exposed to hospital acquired infections, increasing hospital bills, weakness, anxiety and depression. The best direction for a patient when first diagnosed is have a multidisciplinary team involved from the beginning. Physical therapist, nutritionist, rehabilitation centers and family support are all a part of the patient’s successful recovery.

Once a patient has had a cardiac event there are a few things that need to happen before discharge. First, education on the disease process, lifestyle changes, nutrition and possibly wound care. Appointments need to be arranged before the patient leaves the hospital. The patient needs an appointment with the cardiologist and with a physical therapist at a cardiac rehabilitation facility. Cardiac rehabilitation reduces hospital readmission, the progressive deterioration of heart failure and the mortality rate (Achttien et al, 2015). Once strong enough, regular exercise becomes very important, and most insurances for the elderly offer discounted or free gym memberships. Also, a change in eating habits will be necessary. A dietitian while in the hospital can assist with education on the proper foods to eat to be heart healthy.

Changing one’s entire lifestyle is difficult to do, even after a significant event like a heart attack or COPD exacerbation. Changes usually come slowly even with as much assistance as healthcare workers can give. Unfortunately, readmission happen more often than a hospital like to see. If a patient is readmitted within 30 days of being discharged to an inpatient facility CMS and other insurance payers charge penalties to the hospital. Readmission are very costly to a hospital and its budget (HealthStream, 2021). Readmission is also costly and can cause depression and anxiety. It shows that the patient either didn’t do what he/she was educated on when first leaving the hospital or the patient physically wasn’t ready to be discharged.

References:

Achttien, R.J., Staal, J.B., van der Voort, S. et al. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline. Neth Heart J 23, 6–17 (2015). https://doi.org/10.1007/s12471-014-0612-2

HealthStream. April1, 2021. The Economic and Emotional Cost of Hospital Readmission. https://www.healthstream.com.