Cardiac Acute Care Nurse Practitioner and 30-Day Readmission

David, Daniel; Britting, Lorraine; Dalton, Joanne

doi:10.1097/jcn.0000000000000147

Cited by 30 publications

(53 citation statements)

References 20 publications

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“…We also had no data on the effect of ACS nurse roles on patient outcomes, but other studies have documented the impact of nursing roles on outcomes (David, Britting, & Dalton, ; Johnson et al., ; Mehta et al., ; Smallwood, ). Patients with STEMI, NSTEMI and heart failure in the USA admitted to coronary care by a team that included a cardiac advanced practice nurse (CAPN) had 30‐day re‐hospitalization rates 50% lower than those admitted by a team without the CAPN.…”

Section: Discussionmentioning

confidence: 99%

“…Although the 185 patients (78% NSTEMI) were not randomised, there were no significant differences by demographics, clinical characteristics or interventions between the groups. The better outcomes were attributed to the continuity provided by the CAPN, relationships built with multi‐professional teams in acute and community services, expertise developed and the teaching and family support provided by the CAPN (David et al., ). Other studies have found greater NSTEMI patient satisfaction with information when a specialist nurse was involved and greater adherence to guideline‐based care (Johnson et al., ; Mehta et al., ; Smallwood, ).…”

Section: Discussionmentioning

confidence: 99%

“…We also had no data on the effect of ACS nurse roles on patient outcomes, but other studies have documented the impact of nursing roles on outcomes (David, Britting, & Dalton, 2015;Johnson et al, 2009;Mehta et al, 2006;Smallwood, 2009 were not randomised, there were no significant differences by demographics, clinical characteristics or interventions between the groups.…”

Section: Discussionmentioning

confidence: 99%

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Aligning the planets: The role of nurses in the care of patients with non‐ST elevation myocardial infarction

et al. 2016

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BackgroundStudies have shown variation in care for patients with non‐ST elevation myocardial infarction (NSTEMI), including in the roles of specialist and advanced practice nurses in diagnosis, treatment and coordination of care.AimThe aim of this study was to describe the roles and responsibilities of specialist and advanced practice nurses in providing care for patients with NSTEMI.MethodsSecondary analysis of observational field notes and interviews from an ethnographic study of variation in care for NSTEMI patients in 10 UK hospitals conducted 2011–2012. Data were thematically analysed to identify key concepts and themes related to the roles of specialist nurses.ResultsSeven of 10 hospitals had roles for specialist nurses in NSTEMI care. The major theme related to high demand and the complexity of patients and organizations (‘Aligning the planets’). In this theme, nurses contributed to improving services or compensating for deficiencies (‘Making the system work versus making up for the system’). Data collection for audit could take precedence over time with patients (‘Paying worship to the paper’). Nurses expressed a sense of ownership of cardiovascular patients that drove their desire to provide quality of care (‘They are our patients’).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Aligning the planets: The role of nurses in the care of patients with non‐ST elevation myocardial infarction

et al. 2016

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“…As such, programs that aim to reliably enhance access to postdischarge care and augment self‐care are among the most effective in reducing 30‐day readmissions . This includes transitional programs that leverage advanced health care professionals, such as nurse practitioners (NPs) . We aimed to pilot an NP‐driven program focusing on increased access to outpatient care in the post‐LT discharge setting and to evaluate its impact on 30‐ and 90‐day hospital readmissions.…”

mentioning

confidence: 99%

“…(9) This includes transitional programs that leverage advanced health care professionals, such as nurse practitioners (NPs). (10)(11)(12) We aimed to pilot an NP-driven program focusing on increased access to outpatient care in the post-LT discharge setting and to evaluate its impact on 30-and 90-day hospital readmissions.…”

mentioning

confidence: 99%

An Advanced Practice Practitioner–Based Program to Reduce 30‐ and 90‐Day Readmissions After Liver Transplantation

et al. 2019

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Hospital readmissions after liver transplantation (LT) are common and associated with increased morbidity and cost. High readmission rates at our center motivated a change in practice with adoption of a nurse practitioner (NP)–based posttransplant care program. We sought to determine if this program was effective in reducing 30‐ and 90‐day readmissions after LT and to identify variables associated with readmission. We performed a retrospective cohort study of all patients undergoing LT from July 1, 2014, to June 30, 2017, at a tertiary LT referral center. A NP‐based posttransplant care program with weekend in‐house nurse coordination providers and increased outpatient NP clinic availability was instituted on January 1, 2016. Postdischarge readmission rates at 30 and 90 days were compared in the pre‐exposure and postexposure groups, adjusting for associated risk factors. A total of 362 patients were included in the analytic cohort. There were no significant differences in demographics, comorbidities, or index hospitalization characteristics between groups. In the adjusted analyses, the risk of readmission in the postexposure group was significantly reduced relative to baseline at 30 days (hazard ratio [HR] 0.60, 95% confidence interval [CI], 0.39‐0.90; P = 0.02) and 90 days (HR, 0.49; 95% CI, 0.34‐0.71; P < 0.001). Risk factors positively associated with 30‐day readmission included peritransplant dialysis (HR, 1.70; 95% CI, 1.13‐2.58; P = 0.01) and retransplant on index hospitalization (HR, 10.21; 95% CI, 3.39‐30.75; P < 0.001). Male sex was protective against readmission (HR, 0.66; 95% CI, 0.45‐0.97; P = 0.03). In conclusion, implementation of expanded NP‐based care after LT was associated with significantly reduced 30‐ and 90‐day readmission rates. LT centers and other service lines using significant postsurgical resources may be able to reduce readmissions through similar programs.

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Randomized Pilot Trial of Pre‐ and Postoperative Heart Failure Nurse‐Supported Care in Heart Failure Patients Requiring Noncardiac Surgery—Feasibility and Results

Herrmann,

Raghavan,

Tekeste

et al. 2024

Clinical Cardiology

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IntroductionThe perioperative cardiovascular management of patients undergoing noncardiac surgery is particularly challenging in those with pre‐existing heart failure (HF). This study was designed to evaluate the effectiveness of nurse‐based pre‐ and postoperative specialized HF management in reducing postoperative HF‐associated complications in patients with known HF undergoing noncardiac surgery.MethodsThis prospective, randomized pilot study included patients with established HF requiring intermediate‐ to high‐risk noncardiac surgery. Patients received postoperatively either standard care (control group, CG) or nurse‐supported HF management (intervention group, IG). The primary endpoint was a composite of HF‐related postoperative complications at 30 days. Secondary endpoints included length on intensive care unit, length of hospital stay, death, hospitalization for HF, and quality of life assessment using the SF‐12 questionnaire.ResultsThe trial was halted prematurely for futility. A total of 34 patients (median age 70.5 [IQR 67–75] years; with 15 HfpEF, 9 HfmrEF,10 HfrEF), with an average NT‐proBNP of 1.413 [463–2.832] pg/mL were included. The IG had a lower rate of postoperative primary events (25%; n = 4) compared with the CG (33%; n = 6). There were no differences in secondary endpoints between the groups. Quality‐of‐life scores improved slightly in both groups (δ 5.6 ± 0.9 [CG] and 3.1 ± 1.2 [IG]).ConclusionNurse‐based pre‐ and postoperative HF care appears to be feasible and may reduce HF‐associated complications in patients undergoing noncardiac surgery. Larger clinical trials are needed to further evaluate the effectiveness of this approach in reducing postoperative complications in this high‐risk patient population.

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Cardiac Acute Care Nurse Practitioner and 30-Day Readmission

Abstract: The addition of a cardiac acute care NP to medical teams caring for myocardial infarction and heart failure patients had a positive impact on 30-day emergency department return and hospital readmission rates.

Cited by 30 publications

References 20 publications

Aligning the planets: The role of nurses in the care of patients with non‐ST elevation myocardial infarction

Aligning the planets: The role of nurses in the care of patients with non‐ST elevation myocardial infarction

An Advanced Practice Practitioner–Based Program to Reduce 30‐ and 90‐Day Readmissions After Liver Transplantation

Randomized Pilot Trial of Pre‐ and Postoperative Heart Failure Nurse‐Supported Care in Heart Failure Patients Requiring Noncardiac Surgery—Feasibility and Results

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