Executive Summary
Patient education is essential for preventive techniques and for reducing the risk of readmission. The current program only includes a short learning session on the day of discharge. This system leads to high readmission rates and decreased patient awareness of healthy habits.
While it is more effective than not providing the public with any information, it can be improved (Cui et al., 2019). To address this issue, this project proposes implementing a longer educational course beginning on the day of admission. The goal is to decrease the readmission rates from 30% to 20% by July 1, 2024.
According to financial analysis, this change will significantly benefit the hospital’s budget. The total cost of introducing this method is relatively minor compared with the projected expenses associated with additional readmission days (Appendix C, Financial Cost Analysis). The anticipated savings equal $115,006 in the first year and $118,752 in the second year, making the project feasible and worth the funding. In addition, the program’s potential benefits include expanding its use to other diseases, further reducing the costs of rehospitalizations. Therefore, this project should be supported and fully funded to enhance preventive mechanisms in public healthcare substantially and lay the groundwork for future quality improvements.
Project Description
Congestive heart failure (CHF) is a severe problem that affects a patient’s quality of life and life expectancy. This issue includes common readmissions due to relapses and inadequate rehabilitation (Bamforth et al., 2021). A systematic review by Son et al. (2020) suggests this may be improved by providing specialized education to patients at risk of adverse effects and the following conditions.
This phenomenon is supported by Cui et al. (2019), who performed a randomized controlled trial on the impact of targeted educational programs on hospital readmissions and self-management skills. Studies by Dessie et al. (2021), Niman et al. (2020), and Sun et al. (2019) yield comparable results, highlighting the benefits of preventive measures over repeated emergency assistance. Therefore, substantial theoretical support for the benefits of patient education and a calculated decrease in readmissions among intervention groups.
This project will improve the current system by increasing the exposure to specialized patient training, starting the program from admission to discharge. This decision will allow the nurses to dedicate more time to transferring crucial disease-related knowledge to the person with CHF. The article by Cui et al. (2019) features a sample that used the proposed timeline and demonstrates noticeable results: only 5 patients in the intervention group were readmitted, compared to 13 in the control group. Son et al. (2020) mention that the time of education affects the quality of post-discharge rehabilitation, and the lack of proper prevention leads to early deterioration. Therefore, this program will reduce readmission risk more effectively than the current system.
The program’s effect will be economically beneficial, as it will reduce readmission costs. The hospital’s resources will be redistributed from providing care to patients who experience relapse to those who require initial help. Thus, the establishment’s mission will be fulfilled more fully, as it can guarantee that personnel’s skills are applied to maximize potential. As a result, the microsystem will be more efficient in the context of healthcare and prevention.
Market Analysis
The current system cannot reduce the readmission rate after the initial hospitalization. The present state only provides a one-day instruction during the discharge process, making it less effective as a preventive measure (Appendix A, Gap Analysis). This issue results from a lack of specific nurse training and from using general information as a basis for course planning. This leads to higher readmissions and can be addressed by increasing the duration of patient education (Son et al., 2020).
To achieve this, an essential training protocol must be created and implemented in everyday practice with CHF patients. This will allow for more productive courses and reduce post-discharge complications (Cui et al., 2019). Thus, the specific action steps include protocolizing education programs and training professional staff.
The incorporation of standardized materials will make information about CHF more accessible. As the SWOT analysis (Appendix B) suggests, the current weaknesses in the quality of sources may pose a threat of inconsistent outcomes. However, a modernized program will create more opportunities for community partnerships and improve telemedicine. The internal forces that can halt this project are the cost of constructing a cohesive course and the additional hours required for nurse educators. Otherwise, a high-quality program will improve its efficiency.
Externally, it may be negatively affected by healthcare regulations and their standards for public health information. Positive external factors may include existing courses that can be adapted for this project. Moreover, if the results show an increase in healthcare quality, it can attract more grants and investors, compensating for unpredictable liabilities. Therefore, informative education programs will benefit patients’ health prognosis and the hospital’s economic status.
Goal and Objectives & Evaluation Metrics
The goals and objectives of a project like this must be achievable and measurable. The results may be measured as the percentage of patients who are readmitted with CHF after their initial discharge. Currently, this equals 30% and, with the implementation of a new strategy, may drop to 20% by July 1. Even if this timeframe will not be enough to represent the effect of the new technique, it will show the trend of the measured metric. Therefore, this project aims to improve the educational process and decrease the readmissions after CHF from 30% to 20% by July 1, 2024.
Additional features may be measured to assess the project’s success. The hospital’s economic status after implementation may be compared with pre-change conditions. A questionnaire may be used as a metric of nurses’ satisfaction with work and their impression of the project’s effectiveness. In addition, basic CHF-related tests can help evaluate patients’ overall awareness of risk factors and essential habits for preventing relapses. Thus, these methods will reflect improvements in the education process and enable productive adjustments.
Presentation of Options
There are three main options regarding the outcomes of this project. The first option is not to implement the changes and keep the status quo. In short, this will lead to a stagnant readmission rate and a low level of CHF-related knowledge among patients, as the analysis of the current status suggests (Appendix A, Gap Analysis).
However, the long-term implications include a gradual reduction in preventive measures and an ongoing weakness stemming from a lack of protocolized, standardized education programs. This decision generates economic and productivity risks, creating a need for change. Therefore, this option can potentially be detrimental to long-term status and should not be left as is.
The second option involves using the new CHF education system. Although it will require short-term compensation for nurse educators’ work, the most noticeable additional cost is an increase in registered nurses’ (RNs) workloads. At the same time, the expected drop in readmissions will decrease the healthcare-adjacent liabilities. The hourly rate does not vary by activity, making the project cheap relative to the projected cost savings. Thus, creating this program will be cost-efficient and allow the nurses to acquire new skills in patient education.
The third option is a backup plan to be used if any program element proves less effective than expected. If the chosen nurse educator (NE) is unable to provide a comprehensive and applicable protocol for CHF instructions, another professional must be identified. If the RNs report a lack of understanding or difficulties using the provided materials, additional training sessions can be organized to ensure the quality of knowledge and skills. While this may delay the full impact of the program, it will ensure that patients receive professionally curated, accurate advice to prevent complications and adverse effects. As a result, the nurses’ feedback plays an essential role in the project’s success.
Financial Model
Budget
The budget for this project will require assumptions and calculations for several crucial factors, such as expected costs and savings. Appendix C (Financial Cost Analysis) illustrates that the model uses a 1:4 nurse-to-patient ratio to determine the full-time equivalent (FTE) required for seven-day/week coverage. This system calculates the expense of additional hours RNs spend on the updated education project. In addition, the costs include the services of a nurse educator who will present the new protocols, a patient care technician as a monitoring assistant, and materials for learning activities.
The liabilities for subsequent years will continue to provide supplies and include training in competencies, excluding them from the project’s budget. At the same time, the expected avoidances are calculated using a standard cost of one day of CHF readmission multiplied by an average length of stay in current circumstances. As a result, a 10% reduction will yield $118,800 in annual cost avoidance. Thus, the total project savings for the first year will equal $115,006 and $118,752 for the second year.
Financial Analysis
The projected savings represent the possible benefits of implementing the new education program. As the budget suggests, the costs of these additional classes are lower than the potential liabilities associated with readmissions. Moreover, the long-term use of this system will not require other measures, and the only lasting expenses are connected to supplies. This progress may be halted by the need for extra nurse educators’ work, but the savings still overshadow the hourly rate. As a benefit, reduced expenses will allow the hospital to introduce more effective preventive programs or allocate income to recurring professional development courses for staff. Therefore, comparing the options, the choice to implement the program is the most cost-efficient, as it generates substantial savings.
Implementation
The key stakeholders in this project are the nurse educator, cardiologist, registered nurses, patient care technician, and clinical nurse leader (CNL). The nurse educator’s collaborative work with a cardiologist and CNL will be central to the program’s success. Their responsibilities will include developing an instruction course that is transferable and comprehensive for RNs and patients of diverse backgrounds. Moreover, this information must be adaptable to varying lengths of stays, as the number of available days may differ depending on circumstances and the rehabilitation process.
Internally, this team will have shared and individual goals. The cardiologist will provide accurate data on possible patients’ lifestyle changes and their expected effect on future readmissions. Alternatively, they can suggest an existing program and advise on how to use it.
The nurse educator will evaluate the quality of the information and structure it in accordance with the course’s design. CNL must analyze the results of the collaborative work and protocolize it for practical use, including the objectives and standards for daily practice. Therefore, this team will design the course, which will later be transferred to RNs.
After the course is created, the RNs, CNLs, and patient care technicians will serve as the primary operators. The CNL will observe the RNs’ understanding of the program and their ability to instruct patients on preventive measures for CHF. Patient care technicians will support the evaluation of the course’s effectiveness and the observation of patients’ reactions to the acquired information.
As the timeline (Appendix D) shows, the practical use of designed programs must begin by February 2024. This deadline will allow for data collection sufficient to represent trends in readmission rates. Therefore, the RNs must be instructed and ready to perform education sessions by that date. After a month, the CNL will gather initial feedback from nurses to help adjust the program and make it more effective. Thus, preparatory work must be completed by the end of January, and additional changes can be made after the 30-day trial period.
Feasibility Statement and Conclusion
As the project’s expected economic and productivity evaluations suggest, the program’s outcomes will substantially benefit patients and the host establishment. The current situation does not create good circumstances for improving the CHF patients’ quality of life and rehabilitation. The suggested extension of healthcare education will present an opportunity to prevent complications and readmissions. As a result, the hospital can save on its budget by introducing low-cost measures.
The current threats and weaknesses stemming from the lack of standardized programs can be addressed through resident cardiologists and nurse educators, who will develop a cohesive, appropriate set of classes. As a result, patients at risk after discharge will be more likely to develop preventive habits and healthy behaviors, making them more resistant to similar conditions. Implementing this program could lead to similar projects dedicated to preventing other diseases. Therefore, using these methods in daily practice is crucial as they may be an essential factor in healthcare development.
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.
Cui, X., Zhou, X., Ma, L.-L., Sun, T.-W., Bishop, L., Gardiner, F., & Wang, L. (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. Rural and Remote Health.
Dessie, G., Burrowes, S., Mulugeta, H., Haile, D., Negess, A., Jara, D., Alem, G., Tesfaye, B., Zeleke, H., Gualu, T., Getaneh, T., Kibret, G. D., Amare, D., Worku Mengesha, E., Wagnew, F., & Khanam, R. (2021). Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia. BMC Cardiovascular Disorders, 21(1).
Niman, S., Hamid, A. Y. S., & Yulia, I. (2020). The effect of family psychoeducation on social support among congestive heart failure patients. Dunia Keperawatan, 8(1), 9.
Son, Y.-J., Choi, J., & Lee, H.-J. (2020). Effectiveness of nurse-led heart failure self-care education on health outcomes of heart failure patients: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(18), 6559.
Sun, J., Zhang, Z.-W., Ma, Y.-X., Liu, W., & Wang, C.-Y. (2019). Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors. World Journal of Clinical Cases, 7(16), 2165–2175.
Appendix A: Gap Analysis
Appendix B: SWOT Analysis
Appendix C: Financial Cost Analysis
Appendix D: Project Timeline
