Fall 2021

Document Type

Scholarly Project


College of Nursing

First Advisor

Ronda Hughes


Individuals with a heart failure (HF) diagnosis have a high risk of readmission following hospital discharge, increasing care costs. In an academic medical center (AMC) in Charleston, SC, the all-patient-related DRG of HF had 576 30-day readmissions for FY 2020, equivalent to a 26.3% readmission rate. This project aimed to decrease the readmission rate of adult patients diagnosed with HF admitted to cardiac units in the AMC by expanding the discharge bundle. The current discharge process is not bundled. The discharge bundle elements include HF education, pharmacy medication reconciliation, medication counseling, and appointment to the HF clinic prior to discharge. The nurse assessment of patient readiness for discharge using the Readiness for Hospital Discharge Scale (RHDS) was used to identify high-risk patients for readmission. Fifty-seven patients were initially included in the data collection process. Six patients were removed due to observation status and hospice and long-term facility discharges. There were no missing data. The total enrolled patients for the project was 51. A two-way between-group analysis of variance was conducted to explore the impact of the HF bundle and RHDS assessment on readmission rates. Patients were divided into two groups based on whether or not they were readmitted. The interaction effect between the DC bundle and RHDS assessment score was not statistically significant, F (2, 63) = 1.24, p = .32. Post-hoc comparisons using the Tukey HSD test indicated that the mean RRS for the readmitted HF patients (M = 23.54, SD = 4.35) was significantly different from the non-readmitted HF group (M =21.36, SD = 3.49).


© 2021, Leah Caccam Ramos

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