Unplanned hospital readmissions: a home care perspective.

BACKGROUND: The extensive literature concerning hospital readmissions is grounded in a medical or hospital perspective, and fails to address hospital readmissions during home care. OBJECTIVES: To describe clients who have unplanned returns to an inpatient setting during the first 100 days of home care service delivery. METHOD: Using the Hospital Readmission Inventory (HRI), an audit tool with previously established validity and reliability, 916 medical records for clients from 11 midwestern home care agencies were reviewed retrospectively. RESULTS: Typically, clients were referred for their first home care admission after a 9-day hospital length of stay for a cardiovascular, respiratory, or neoplastic disorder. After an average 18-day length home care stay, clients were readmitted to the hospital, usually due to the development of a new problem, or due to deterioration in health status related to the primary or to a secondary medical diagnosis. Significant respiratory, cardiovascular or GI symptoms were generally present at hospital readmission. Typically, readmitted clients were 75 year old married females, who had been able to care for themselves at home. At hospital readmission, home care nurses judged these clients to be moderately ill, and likely in need of acute care. CONCLUSIONS: Chronic illness appears to be the best indicator for hospital readmission. The crucial time period for hospital readmission during home care is the first 2-3 weeks following hospital discharge. Intensive study of home care service arrangements utilized by readmitted patients, as well as agency variations, are needed. Study findings concerning patients readmitted from home care point to similarities with rehospitalized patients generally. Findings may assist home care clinicians in targeting high risk patients who could benefit from interventions aimed at minimizing unplanned returns to the hospital.

Postpartum home visits: infant outcomes.

Early postpartum discharge of mothers and infants has increased as health care providers and payers attempt to control health care cost. Questions regarding patient safety have been raised. Literature supports the safety of early discharge when providers adhere to strict discharge guidelines and when clients comply with home follow-up. Previous studies calculated hospital readmission rates, but few examined other outcomes or characteristics. The purposes of this descriptive study were to examine outcome data for infant participants in a postpartum home visit program and to explore factors that may influence hospital readmissions for infants. Using an audit tool with established reliability and validity, a convenience sample of 199 infant medical records was reviewed for demographic information, characteristics, and outcomes. The hospital readmission rate for all infants within 3 weeks of discharge was comparable to other studies; however, the rate for only early discharge infants was higher than the rate reported in other studies. The study of postdelivery outcomes for infants provides additional insight into the issue of early discharge and may reflect the significance of postpartum follow-up care and education.

Home care referral after emergency department discharge.

OBJECTIVE: The purpose of this study was to assess the need for home health care referral screening for elderly patients after ED discharge. The specific research question addressed was: Is there a need for home care referral screenings for elderly patients discharged from the emergency department? DESIGN: A nonexperimental, retrospective, descriptive design was used in this project. METHODS: A convenience sample of 194 closed medical records was obtained from a Midwestern hospital emergency department. The medical records were from patients 65 years of age and older who had visited the emergency department during a 3-month period. One chart audit tool was completed for each medical record. RESULTS: Eighty-eight (45.4%) of the 194 patients in the study could have benefited from a home care referral. CONCLUSION: Elderly patients frequently access the health care delivery system through the emergency department, but little is known about the outcomes of such usage, particularly in the context of continuity of care. If home care referral screenings of elderly ED patients are performed and appropriate referrals are made before ED discharge, a seamless delivery system of health care is provided. A home care visit resulting from a referral may be all that is needed for the maintenance of a patient's condition. To improve the quality and continuity of patient care, home care screening should be integrated into the routine discharge ED activities.

Hospital readmissions during home care: a pilot study.

The health care delivery system has undergone dramatic shifts in care settings during the past decade. More patients are receiving professional home care following discharge from hospitals, skilled-care facilities and rehabilitation centers. Home care is considered to be an integral part of patient recovery. Skilled nursing care delivered in the patient's home may prevent, forestall, or limit costly readmissions to an inpatient setting. Home care professionals have long questioned whether the unplanned returns of their clients to hospitals are preventable. The literature is replete with information from the acute-care and medical or physician's perspective concerning readmission. However, clients' unplanned returns to an inpatient setting while receiving home care services has not received much attention. The purpose of this pilot study is to describe clients who have unplanned returns to an inpatient setting during the first 31 days of home care service delivery. Using the Hospital Readmission Inventory (HRI), an audit tool with established validity and reliability, medical records for 68 clients from 8 midwestern home care agencies were reviewed. Readmitted patients were elderly, married females with cardiovascular or respiratory problems who were not independent in health care decision making or in self-care. Clients were readmitted to the hospital after approximately 2 weeks of home care service. The characterization of home care clients who are readmitted to the hospital may assist in targeting high-risk patients who could benefit from interventions aimed at minimizing unplanned returns to the acute-care setting.

First-line nurse managers in rural hospitals: perceptions of career success.

First-line nurse managers in small rural hospitals are essential to organizational survival, yet little is known about such individuals. A pilot study comparing demographic characteristics and career success perceptions of first-line nurse managers from rural settings with doctorally prepared nurses found that despite age and educational differences, personal characteristics identified as contributing to career success were remarkably similar in both groups. First-line nurse managers generally credited family members with greater degrees of career influence than did their more educated colleagues. However, both groups saw themselves as primarily responsible for their own career success. This information may assist rural hospitals and nursing personnel to enhance their strategic position in the unstable environment of health care reform.

Mothers of low birthweight infants: breastfeeding patterns and problems.

The feeding behavior and problems of mothers of low birthweight (LBW) infants following hospital discharge have not been well documented. The purpose of this paper is to report the feeding patterns of LBW infants and their mothers' reasons for a decline in breastfeeding. A convenience sample of 110 mothers and infants from eight midwestern hospitals was surveyed. Eight weeks after delivery, 28 percent of the mothers were providing mother's milk exclusively, 29 percent were providing a combination of mother's milk and artificial milk, and 43 percent had weaned their infants. An inductive analysis of the reasons for a decline in breastfeeding given by the mothers yielded two primary maternal concerns: milk production and transfer of milk to the infant. Lactation management strategies that meet the special needs of these mothers and infants should be taught during hospitalization and after hospital discharge.

An analysis of the historical context of liberal education in nursing education from 1924 to 1939.

This study examines in historical context the liberal education theme in nursing education as expressed in nursing literature from 1924 to 1939. The specific questions addressed are: What is the nature of liberal education as presented in the literature of the time? What did nurse educators believe would be the effect of the liberal education of the nurse on the profession of nursing? To what extent did the articulation of beliefs regarding liberal education parallel the development of nursing education at the collegiate level? The data include literature published in the major nursing journals, the proceedings of the national professional nursing organizations, and the major studies of nursing by various committees. The literature was examined for central themes. The study concludes that during this period, nurse educators believed the purposes of a liberal education for nurses to be the development of the individual and the citizen, the acquisition of cultural knowledge, the development of critical thinking, and the possession of a strong science background. A nurse with these abilities would be able to meet the changing demands of practice at a professional level. The college and university continued to be viewed as the optimum site for this education.

Anxiety, inhibition, and conduct disorder in children: II. Relation to salivary cortisol.

The relation of symptoms of conduct disorder (CD) and anxiety to salivary cortisol was explored in 67 clinic-referred boys aged 8 to 13 years. Children with anxiety disorder had higher levels of cortisol, but this main effect was qualified by a significant CD x anxiety disorder interaction. Consistent with Gray's biological model of the behavioral inhibition system (BIS), children with both CD and anxiety disorder had higher levels of salivary cortisol than children with CD without comorbid anxiety disorder. In the absence of CD, however, anxiety disorder was not clearly associated with higher cortisol. This result suggests that cortisol may be a useful biological marker of arousal associated with BIS activity in children with CD.

The emergence of liberal education in nursing education, 1893 to 1923.

This is a study of the liberal education theme in nursing education as articulated in nursing literature from 1893 to 1923. The major questions addressed are: What did nurse educators believe to be the nature of liberal education? What did they believe would be the effect of a liberal education on the profession of nursing? To what extent did the articulation of the beliefs regarding liberal education parallel the development of collegiate-level nursing programs? The resources for this study are viewed in a historical and philosophical context, relating education beliefs, beliefs about professions, and the development of nursing education. The materials used for research include literature published in the major nursing journals of the time, proceedings of the national professional organizations for nursing practice and education, and major studies of nursing by various committees and commissions. The writings of nurse educators were examined for central themes. The study concludes that nurse educators believed the purposes of a liberal education for nurses were to foster the development of the individual, to prepare the individual for citizenship, to provide the individual with a broad knowledge base, and to develop the individual's critical thinking and judgment skills. Practitioners of nursing with these attributes would increase the credibility of nursing's claim to professional status. Although nurse educators believed that institutions of higher education were the logical sites for professional nursing education, the development of collegiate-level educational programs that incorporated a general education as part of the program of study for nursing lagged behind the articulation of beliefs.