EBP Proposal for Reducing Readmissions for Patients with COPD in Our Hospital

Issue: Our hospital has a high readmission rate for patients with Chronic Obstructive Pulmonary Disease (COPD). Readmissions are costly, inconvenient for patients, and can negatively impact their long-term health outcomes.

Proposed Change: Implement a multi-pronged intervention program to reduce readmissions for COPD patients, informed by evidence-based practice (EBP):

1. Early Discharge Planning with Patient Education:

• Evidence: Studies show that comprehensive discharge planning with patient education on disease management, medication adherence, and early symptom recognition can significantly reduce readmissions for COPD patients (e.g., Crain et al., 2015; Gray et al., 2020).
• Intervention: Develop a standardized, individualized discharge plan focusing on:
  • Medication education (proper use, side effects, importance of adherence).
  • Symptom management techniques (early warning signs, exacerbation prevention strategies).
  • Self-monitoring tips (pulse oximetry, symptom tracking).
  • Community resource identification (pulmonary rehabilitation programs, support groups).
  • Follow-up appointment scheduling within 7-14 days.

2. Transitional Care Management:

• Evidence: Post-discharge telephone follow-up by nurses or case managers can improve medication adherence, early problem identification, and reduce readmissions (e.g., Coleman et al., 2005; Anderson et al., 2011).
• Intervention: Implement a dedicated telephonic case management program for COPD patients discharged within 72 hours. Trained nurses or case managers will:
  • Call patients within 24 hours and weekly for 4 weeks to assess post-discharge concerns.
  • Address medication questions and adherence issues.
  • Provide symptom management support and identify early signs of exacerbation.
  • Refer to appropriate resources or schedule additional appointments if needed.

3. Shared Decision-Making and Advance Care Planning:

• Evidence: Advance care planning discussions and shared decision-making regarding treatment preferences can improve patient satisfaction and potentially reduce unnecessary hospitalizations (e.g., Sudore et al., 2017; Gillick et al., 2006).
• Intervention: Integrate advance care planning conversations into COPD management during hospitalization and during follow-up care. Train healthcare providers to:
  • Discuss prognosis and treatment options with patients in clear, understandable language.
  • Facilitate shared decision-making regarding discharge plans and escalation of care preferences.
  • Document advance directives and ensure family involvement in discussions.

Evaluation:

• Track readmission rates for COPD patients before and after implementing the intervention program.
• Monitor adherence to the program components (discharge planning, telephonic follow-up, advance care planning discussions).
• Conduct patient satisfaction surveys to assess the program’s impact on patients’ understanding of their disease and confidence in managing it.

Timeline:

• Develop and implement the intervention program within 6 months.
• Track and evaluate outcomes for 12 months.
• Refine the program based on findings and continuous feedback.

EBP Framework:

This proposal aligns with the EBP framework by:

• Identifying a relevant clinical problem (high readmission rates).
• Formulating a focused question (can the proposed intervention reduce readmissions?).
• Searching for and critically appraising relevant evidence (research studies supporting the chosen interventions).
• Adapting the evidence to our specific context and patient population.
• Implementing the intervention plan and evaluating its effectiveness.

By implementing this EBP-based intervention program, we hope to significantly reduce readmissions for COPD patients, improve their health outcomes, and achieve cost savings for our hospital.