Hb Case Study

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Clinical Practice Question Will educating SMH ED nurses about signs and symptoms of HF increase their confidence and skill in identifying HF patients?
Critical Appraisal Components: Evidence-Based Factors
The emergency department (ED) is a unique environment that serves as a gatekeeper for patients with a variety of illnesses and is the source of a majority of admission. With so much scrutiny on patient care benchmarks and admission and readmission rates, the ED is an area of special interest to initiate any new protocols.
Recognizing that in a realistic setting, resources are limited the authors Amarasingham et al (2013) wanted to assess whether stratification of patient risks would reduce HF readmissions and better allocate limited care
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The authors suggested that a large portion of HF patients who were admitted could be avoided as the patients commonly suffer from congestion and require diuresis; yet they are often admitted due to an unclear plan of care at discharge. The authors also cited that HF patients who were admitted had a high rate of post-discharge events and complications within 60 to 90 days at 20% - 30%, and patients discharged from the ED had even higher rates, but there were no indication that hospitalization would decrease such events or complications from …show more content…
2) A multidisciplinary care consisting physicians, nurses, socials workers, and pharmacists.
3) Frequent contacts with providers via telephone or in person.
4) Patient education with emphasis on self-care at home.
5) Early discharge planning and support if hospitalized.
6) A means to measure process and outcome.
Horwitz and Krumholz (2016) further analyzed data regarding HF clinics and infusion centers in post-discharge and outpatient settings. Although the concept of a dedicated heart failure clinic and outpatient center is still on the rise and data in this area more limited than other approaches, the authors did find that two of the three facilities reviewed showed reduced three to six month readmission and mortality rates.
As shown, appropriately capturing the right patient population in the emergency department is integral in initiating interventions, education, and early discharge planning. By educating the nursing staff to recognize signs and symptoms of HF, the patients may be quickly targeted to receive early interventions and outpatient services

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