1. By Megan Kells

2.  New law mandates that government funded insurances are not responsible for expenses of readmissions within 30 days.  Government’s Perspective: readmissions within 30 days are an indicator of overly expensive and uncoordinated health systems  Medicare is spending 17.5 billion a year in 30 day readmission expenses.  Hospitals unable to decrease hospital readmission rates will lose more than 280 million dollars in government funds

3.  Known for recurrent readmissions especially within 30 days of discharge  Heart failure is the most common Medicare diagnosis-related group  More Medicare dollars are spent for diagnosis and treatment of HF than for any other diagnosis.  In the last 10 years, the annual number of hospitalizations for HF has increased from 550,000 to 900,000  There are 500,000 new cases each year

4.  What variables contribute to high readmission rates?  What can improve or reduces the variables that cause high readmission rates?

5.  Empower RNs at beside  A lengthy Nurse Practitioner consult that provides time for questions and answers session.  Have follow up appointments scheduled prior to discharge.  Address other identified barriers to compliance  Follow up phone calls or, in some cases, home visits

6.  A Team of RNs working from admission to post discharge.  A Nurse Practitioner who is readily available  Multi- discipline coordination with out patient care

7.  Innovation “An innovation is an idea, practice, or project that is perceived as new by an individual or other unit of adoption” (Rogers, 2003, p. 12).  Consequences of the new idea and uncertainty i.e. Function vs dysfunction, anticipated vs unanticipated

8.  Communication Channels “a process in which participants create and share information with one another in order to reach a mutual understanding” (Rogers, 2003,p. 5).

9.  Time Working in a time frame from admission to post discharge

10.  Social System “a set of interrelated units engaged in joint problem solving to accomplish a common goal” (Rogers, 2003, p. 23).

11.  Low Income population Cannot afford medications, cannot afford compliance  IV drug users  Start plan with assessing Maslow’s Hierarchy of needs. If patient is agreeable get psych on board as well as social work.

12.  Parentalism  Dependency  Language

13.  Documentation  Political involvement  Health policy influence

14.  Ballard-Hernandez, J. (2010). Nurse practitioners improving the transition from hospital to home \and reducing acute care readmission rates in heart failure patients... 2010 AAHFN 6th Annual Meeting, June 24-26, 2010. Heart & Lung, 39(4), 365-366.  Martin, G. (1998). Communication breakdown or ideal speech situation: the problem of nurse advocacy. Nursing Ethics, 5(2), 147-157. doi:10.1177/09697330980050020610.1191/096973398674149320  McManus, S. (2004). A telehealth program to reduce readmission rates among heart failure patients: one agency's experience. Home Health Care Management & Practice, 16(4), 250-254.  Rau, J. (2012, August 13). Medicare to penalize 2,217 hospitals for excess readmissions. Retrieved from http://www.kaiserhealthnews.org/stories/2012/august/13/medi care-hospitals-readmissions-penalties.aspx http://www.kaiserhealthnews.org/stories/2012/august/13/medi care-hospitals-readmissions-penalties.aspx  Sain, I. (2006). Detailed review of Rogers’ diffusion of innovations theory. The Turkish Online Journal of Educational Technology, 5(2),