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Item type Presentation

Format Text-based Document

Title Role of Advanced Practice Nurses in Decreasing Length ofStay and Rehospitalization for Heart Failure Patients

Authors Mersha, Sisay

Downloaded 11-May-2018 22:17:35

Link to item http://hdl.handle.net/10755/304324

THE ROLE OF ADVANCED PRACTICE NURSES IN DECREASING LENGTH OF

STAY AND REHOSPITALIZATION FOR HEART

FAILURE PATIENTS: A SYSTEMATIC REVIEW

Sisay B. Mersha, DNP,MS, ACNP-BC

1

My Hometowns

Chicago

2

The first APN program in the United States was launched in 1965 by Dr. Loretta Ford in collaboration with Dr. Henry Silver at the University of Colorado as a non-degree certificate program.

Brief History of APN profession in the U.S.A

3

Progressively APNs education and responsibilities keep growing until our time, when APNs area of practice virtually is in every specialty (E.g, Primary Care , Cardiology, Hospitalist, etc)

Brief History of APN profession in the U.S.A

4

Heart failure (HF) is a chronic debilitating illness that affects millions of Americans each year and these patients are faced with chronic physical symptoms, emotional strain, and significant socioeconomic burden.

Background & Significance of the Problem

5

Complex and costly chronic disease process associated with

high morbidity and

mortality

Background & Significance of the Problem

6

Common Causes of Heart Failure Underlying Causes

Structural abnormalities

Fundamental causes Biochemical and physiological mechanisms

increased hemodynamic burden

Precipitating causes Arrhythmias

Systemic infections

Background & Significance of the Problem

7

5.7 million patients with Heart Failure in the United States

670,000 new cases added to this pool

every year

24.7% (26.9% for Medicare) become readmitted within 30 days of their discharge

Background & Significance of the Problem

8

Average LOS for HF patients is 4.0 days (ranges 2.3-9.5 days; 10th %tile (3.1 days) and 90th %tile(5.0 days)

In 2005, 1 in 8 death certificates, mentioned HF

Case fatality rates 30-day-10.4%, 1 yr-22% & 5 yrs-42.3%

Background & Significance of the Problem

9

The estimated direct and indirect average annual cost of HF in the United States is $30 Billion (ACC, 2013)

The lifetime cost of a single HF patient is more than $109,541 with a mean cost of $83,980 (Dunlay et al, 2011)

Background & Significance of the Problem

10

The purpose of this Systematic Review was to explore “The role of Advanced Practice Nurses in preventing unnecessary length of stay and reducing rehospitalizations for heart failure patients within 30 days post discharge”

Purpose of the Literature Review

11

33% of HF pts are readmitted to hospitals within 90 days & 50% of these is caused by

acute Decompensation None adherence with either diet guidelines or medications or both

(Mueller, et al., 2002)

APNs as Care coordinator, excellent patient educators, case managers or primary care providers

(Sidani and Doran, 2009; Albert et al., 2010; Newhouse et al., 2011; Schroeder, Trehearne, & Ward, 2000)

Background & Significance of the Problem

12

Inclusion Criteria Studies published from 1990-2011

English Language literatures

Studies that focused on the role of APNs (both NP and CNS roles included) in reducing LOS & readmission rates among heart failure patients.

Methodology, Data Collection & Data Analysis

13

Article Review n=42 26 studies eliminated due to their theme not

specifically talking about LOS & Readmission rate.

Final Aggregate Outcome n=16 2 articles eliminated for being out of the

context for HF

Final Aggregate Outcome n=14

Methodology, Data Collection & Data Analysis

14

Main Themes APNs role in reducing length of stay APNs role in reducing rehospitalization APNs role in reducing cost

Other Themes APNs role in increasing patient

satisfaction APNs role in improving life styles changes

(Quality of Life) and promoting self-care behaviors of patient

Themes Extracted from the Selected Articles

15

1.APNs role in reducing length of stay

Length of hospital stay is reduced significantly, to an average of 3.5 days, when APNs are involved in the care coordination and education of patients

(Albert et al, 2010; Crowther, 2003; Delgado-Pasler, 2005; Bixby et al., 2000; Crowther et al, 2003; Brooten et al., 2003; Kegel, 1995; Newhouse et al., 2011; Naylor et al., 2004; Schroeder et al.,2000; McCauley et al., 2006)

Themes Extracted from the Selected Articles

16

2. APNs role in reducing rehospitalization

When APNs are used in a Practice:

Time to next rehospitalization is longer

Fewer deaths

(Crowther, M., 2003; Albert et al., 2010; Delgado-Pasler, 2005

Bixby et al., 2000; Crowther, et al., 2003; Dahll et al., 2000

Naylor et al., 1994.; Schroeder et al., 2000; McCauley et al., 2006)

Themes Extracted from the Selected Articles

17

3. APNs role in reducing cost

Lower mean total cost

Presence of mid-level practitioners in 112 practices of 167 proved that hiring one or more mid-level providers, such as APNs, is related to cost saving $4,845 (Albert et al.2010; Delgado-Pasler, 2005; Schroeder et al., 2000; Brooten et al., 2003)

Themes Extracted from the Selected Articles

18

Other additional themes extracted

1. APNs role in increasing patient satisfaction

Relationship with their patients (Relationship-based care)

(Naylor et al., 1994; Schroeder et al., 2000; McCauley et al.,

2006)

Themes Extracted from the Selected Articles

19

2. APNs role in improving life styles changes (Quality of Life)

and promoting self-care behaviors of patient

APNs intentionally involved in their patients’ life style and use this opportunity to improve patients’ life

(Smuelders et al., 2010; Crowther, M., 2003; Delgado-Pasler,

2005; Bixby et al., 2000; Dahll et al., 2000; Schroeder et al., 2000; Brooten et al., 2003; McCauley et al., 2006)

Themes Extracted from the Selected Articles

20

The systematic review of the published literatures Shows

Advanced Practice Nurses have a great impact in reducing unnecessary length of hospital stays and reducing rehospitalizations after discharge through relationship-based care and care coordination

Discussion

21

The systematic review of the published literatures Shows

Life style changes and Adherence to diet/medication guidelines is more practical when APNs are evolved in the care of HF patients.

Discussion

22

The use of APNs in practices implies significant contributions in the United States healthcare system in terms of :

Decreasing LOS,

Preventing readmissions and

Reducing overall healthcare cost.

Through relationship-based care

Implications to Practice

23

Outcome measures such as

Patient satisfaction,

Treatment and diet compliance and

Improved quality of life are comparable or better when using APNs than no APNs in a given practice.

Implications to Practice

24

This will encourage practices and/ or hospitals to hire more APNs as Hospitalsists.

Further Opportunities exist as patient & Family centered Cares evolve and become the buzz word.

Implications to APNs

25

HF Failure program is one opportunity that the surveyed hospitals may use to decrease LOS and Rehospitalization.

APNs can be instrumental in attaining this goal

Challenges to get a buy in from front line stake holders such as attending physicians, cardiologists, & ED providers as well as Finance and Administration are all important miles stones before launching the program.

Conclusion

26

Reference ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. Retrieved on August 7th, 2012 from http://content.onlinejacc.org/cgi/content/full/j.jacc.2008.11.013 Albert, N. M., Fonarow, G. C., Yancy, C. W., Curtis, A. B., Stough, W. G., Gheorghiadeet al. (2010). Outpatient cardiology practices with advanced practice nurses and physician assistants provide similar delivery of recommended therapies (findings from IMPROVE HF). Am J Cardiol, 105(12), 1773. doi:10.1016/j.amjcard.2010.01.360 Boyd, K. J., Worth, A., Kendall, M., Pratt, R., Hockley, J., Denvir, M., & Murray, S. A. (2009). Making sure services deliver for people with advanced heart failure: A longitudinal qualitative study of patients, family care givers, and health professionals. Palliat Med, 23(8), 767. doi:10.1177/0269216309346541 Brandon, A. F., Schuessler, J. B., Ellison, K. J., & Lazenby, R. B. (2009). The effects of an advanced practice nurse led telephone intervention on outcomes of patients with heart failure. Appl Nurs Res, 22(4), e1. doi:10.1016/j.apnr.2009.02.003 Caboral, M. F. (2006). Putting the 2005 american college of Cardiology/American heart association heart failure guidelines into clinical practice: Advice for advanced practice nurses. Topics in Advanced Practice Nursing, 6(2) Caboral, M. F., & King, W. V. (2008). Guidelines update on the prevention of heart disease in women. Journal of the American Academy of Nurse Practitioners, 20(4), 191-193.

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Dunlay, S.M., Shah, N.D., Shi, Q., Morlan, B., VanHouten, H., Long, K.H., Roger, V.L(2011).Lifetime costs of medical care after heart failure diagnosis. Cardiovascular Quality & Outcomes. Jan 1;4(1):68-75.

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