Combining training in knowledge translation with quality improvement reduced 30‐day heart failure readmissions in a community hospital: a case study. Issue 2 (24th September 2015)

• Record Type: Journal Article
• Authors: Wyer, Peter; Stojanovic, Zorica; Shaffer, Jonathan A.; Placencia, Mitzy; Klink, Kathleen; Fosina, Michael J.; Lin, Susan X.; Barron, Beth; Graham, Ian D.
• Is Part Of: Journal of evaluation in clinical practice. Volume 22:Issue 2(2016)
• Page Start: 171
• Page End: 179
• Publication Date: 2015-09-24
• Subjects: evaluation -- evidence‐based medicine -- medical education; Clinical medicine -- Periodicals; 616.005
• DOI: 10.1111/jep.12450
• Languages: English
• ISSNs: 1356-1294

Abstract

Abstract: Rationale, aims and objectives: Training programmes in evidence‐based practice (EBP) frequently fail to translate their content into practice change and care improvement. We linked multidisciplinary training in EBP to an initiative to decrease 30‐day readmissions among patients admitted to a community teaching hospital for heart failure (HF). Methods: Hospital staff reflecting all services and disciplines relevant to care of patients with HF attended a 3‐day innovative capacity building conference in evidence‐based health care over a 3‐year period beginning in 2009. The team, facilitated by a conference faculty member, applied a knowledge‐to‐action model taught at the conference. We reviewed published research, profiled our population and practice experience, developed a three‐phase protocol and implemented it in late 2010. We tracked readmission rates, adverse clinical outcomes and programme cost. Results: The protocol emphasized patient education, medication reconciliation and transition to community‐based care. Senior administration approved a full‐time nurse HF coordinator. Thirty‐day HF readmissions decreased from 23.1% to 16.4% (adjusted OR = 0.64, 95% CI = 0.42–0.97) during the year following implementation. Corresponding rates in another hospital serving the same population but not part of the programme were 22.3% and 20.2% (adjusted OR = 0.87, 95% CI = 0.71–1.08). Adherence to mandated HF quality measures improved. Following a start‐up cost of $15 000 US, programme expenses balanced potential savings from decreased HF readmissions. Conclusion: Training of a multidisciplinary hospital team in use of a knowledge translation model, combined with ongoing facilitation, led to implementation of a budget neutral programme that decreased HF readmissions.