Performance Improvement to Decrease Readmission Rates for Patients With a Left Ventricular Assist Device.
Jackeline Iseler, John Fox, Kelly Wierenga
PMID 29558876WHAT IT FOUND
Nurse-led transitional care for heart failure patients showed decreases in rehospitalizations in eight studies.
No included study tested LVAD patients, so direct evidence for moderate-intensity LVAD discharge programs is lacking.
Key findings
01All 13 included studies measured all-cause rehospitalization, and significant decreases were shown in eight studies.
02The interventions were nurse-led bundles that commonly included home visits, phone calls, follow-up appointments, patient education, self-management support, and communication.
03Six studies showed cost savings, and three studies showed significant quality-of-life improvements.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No included study tested transitional care in LVAD patients; 12 of 13 studies had heart failure diagnoses and one had chronic obstructive pulmonary disease as the main diagnosis. Because the interventions were bundles, the review cannot show which single component produced the reductions. The studies were heterogeneous, so the review could not combine effect estimates. It categorized intervention components instead. Some included studies were quasi-experimental, observational, or pilot studies, and randomization or blinding details varied. Quality-of-life and cost outcomes were measured inconsistently across studies.
Declared interests
The article is tagged as Research Support, Non-U.S. Gov't, but no detailed conflicts-of-interest or funding statement appears in the supplied text.
The easy way to misread this
Do not conclude that LVAD readmissions will fall if a nurse-led transitional care program is started. No included study tested LVAD patients, and the positive readmission results came from heart failure or COPD studies.