No abstract

Poor education-related discharge preparedness for patients with heart failure is believed to be a major cause of avoidable rehospitalizations. Technology-based applications offer innovative educational approaches that may improve educational readiness for patients in both inpatient and outpatient settings; however, a number of challenges exist when implementing electronic devices in the clinical setting. Implementation challenges include processes for "on-boarding" staff, mediating risks of cross-contamination with patients' device use, and selling the value to staff and health system leaders to secure the investment in software, hardware, and system support infrastructure. Strategies to address these challenges are poorly described in the literature. The purpose of this article is to present a staff development program designed to overcome challenges in implementing an electronic, tablet-based education program for patients with heart failure. (Critical Care Nurse. 2016;36 A lthough many factors contribute to high rates of hospital readmission for patients with heart failure, inadequate educational preparation for discharge is one factor that is largely avoidable and predominantly managed by nurses.1,2 New electronic, tablet-based patient education platforms, designed to address predischarge gaps in education, are increasingly accessible and linked to electronic health records.3,4 Yet, integrating these tools into nursing workflow is challenging. Staff development initiatives to facilitate adoption of electronic tablet-based patient education in the acute care setting are needed.Louise Saladino, RN To illustrate the gravity of the prevalence and high cost of preventable readmissions, the Agency for Healthcare Research and Quality sponsored work to identify contributing factors. Of the 9 million Medicare hospitalizations yearly, 1 in 5 patients is readmitted within 1 month of discharge. 5 The cost of hospital readmissions is estimated to be $26 billion per year, of which $17 billion is considered preventable.5 Notably, inadequate educational preparation was identified as a common contributor to avoidable readmissions and was established as a target for care redesign. [6][7][8] In 2009, providing written instructions and educational materials at discharge became a critical performance measure in the heart failure clinical practice guidelines for the American College of Cardiology and American Heart Association. 9The Joint Commission and the Centers for Medicare and Medicaid Services also require that discharge instructions include information on medications, worsening symptoms, diet, activity, weight monitoring, and follow-up appointments. [10][11][12] Although clinical practice guidelines and regulatory requirements support the need for more effective education before discharge, the challenges of redesigning traditional paper-based educational content and patient education workflow processes in inpatient care settings are substantial.For nurses, classroom education is shifting to include more contemporary, peda...

No abstract

H ealth care economists have long understood that the Patient Protection and Affordable Care Act (PPACA) could never function as intended. The reasoning behind this bold statement is simple. The PPACA aspires toward an end point that no law, system, or intervention has been able to accomplish: breaking the health care "iron triangle."According to the concept of the health care iron triangle, health care is a tightly interlocked, self-reinforcing system of three vertices-access, quality, and cost-and improvement in two vertices necessarily results in a worsening in the third. 1 Interventions in health care inherently require trade-offs, which prevent simultaneous improvement in all three components.The PPACA is explicitly designed to disrupt this paradox, ambitiously aiming to increase access and improve quality while lowering costs. 2 Emerging evidence suggests, however, that the practical implementation of the PPACA will trump its intended benefits. Though there are numerous ways in which the PPACA could paradoxically decrease access to care, lower the quality of care, or raise costs, the outcome is almost certain that the PPACA may bend-but will never breakthe health care iron triangle.

No abstract