NR 500 Week 5 Graded Discussion: Systems Theory and Practice Issues
Many of you have experience in complex adaptive systems whether you realize it or
... [Show More] not. Thinking about your current or future practice area, identify an issue or concern. In your initial response, please describe the concern. Does the concern primarily occur at the micro, meso, or macro level? How would you address this issue? What impact might your solution have on the other levels of the system? In what ways could interprofessional collaboration be used to resolve the issue?
ANSWER
Professor and Class,
As an ED RN and an RN case manager, I definitely spend my days immersed in complex adaptive systems and their unpredictable environment. An issue of concern is presently the need to reduce readmission rates for the congestive heart failure patients. Although this is a national core measure, for the purpose of this discussion post I will focus on the emergency department where I now work and therefore note that this concern occurs at the microsystem (emergency department) level. Interprofessional collaboration can help ensure that the patients discharged from the ED have the appropriate follow up and the resources to actually make it to the follow up appointment. ED physicians and midlevel providers need to communicate more clearly and directly with the patients and their families, the case managers, and the social workers, in order to come up with a discharge and follow up plan that the patient will be able to adhere to. As of this moment, and as a result of a system-wide initiative, all core measure patients are referred to the RN case manager for screening and early identification of any barriers, if any are present, these can be identified early on and addressed as needed. A common issue we see is that patients do not have transportation to go to their cardiologist or have to wait too long until their appointment in order to be seen. Patients were then returning to the ED for follow up/exacerbations due to lack of appropriate follow up in the community. “Congestive heart failure is recognized as the leading cause of hospitalization in the elderly. The Agency for Healthcare Research and Quality has acknowledged that readmission rates are often attributed to poor coordination and continuity among treatment providers. Nearly 20% of Medicare discharges are followed by an adverse event within 30 days (usually related to medication mismanagement), leading to readmission. Readmission may also be due to poor transitions from hospital to home. For example, the patient and his or her significant others may not have the basic knowledge, skills, or ability to provide necessary follow-up care. This results in a deterioration in patient health well before the post-hospital discharge follow-up appointment.” (Messina, W., 2016).
The hospital where I work conducted a pilot program that then was implemented system wide: a free telehealth program for Medicare recipients who enrolled in the hospital-provided home health care program. The patient needs just a cell phone to be able to participate, no home internet or landline is required. Special equipment such as an electronic scale for daily weights and a BP monitor are provided. The patients and care givers/family receive instructions on how to use them. The data is transmitted electronically via Bluetooth to the patient’s cell phone app and the app in turns provides data to the home health MD and the patient’s cardiologist. A similar program was implemented in a veterans’ hospital in Tampa, FL, and a study of the same found that “the application of telehealth and phone care initiatives reduced the congestive heart failure hospital readmission rate by 5%, decreased costs, and improved veteran satisfaction with overall care experience.” (Messina, W., 2016)
Messina, W. (2016). Decreasing congestive heart failure readmission rates within 30 days at the tampa va. Nursing Administration Quarterly, 40(2), 146-146. [Show Less]