Knowing the patient: Understanding readmission reasons in complex heart failure

Authors

Sara Marzinski, Advocate Aurora HealthFollow
Diane Melrose, Advocate Aurora HealthFollow
Therese Moynihan, Advocate Aurora Health
Jeanne Hlebichuk, Advocate Aurora HealthFollow
Yunqi Liao, Advocate Aurora HealthFollow
Mary Hook, Advocate Aurora HealthFollow

Recommended Citation

Marzinski S, Melrose D, Moynihan T, Hlebichuk J, Liao Y, Hook M. Knowing the patient: Understanding readmission reasons in complex heart failure. Journal of Cardiovascular Nursing. 2023; epub ahead of print. doi: 10.1097/JCN.0000000000001061

Affiliations

Aurora St. Luke's Medical Center

Advocate Aurora Research Institute

Abstract

Background

Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity.

Objective

The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences.

Methods

A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses.

Results

Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2–28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%).

Conclusions

Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.

Document Type

Article