Background Syncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30‐day readmission in patients with syncope. Methods and Results We identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013-2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30‐day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58-83), 53.9% were women, and 9.3% had 30‐day readmission. The most common cause of 30‐day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30‐day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6-0.7), female sex (OR, 0.9; 95% CI, 0.8-0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2-1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3-1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2-1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2-1.3), anemia (OR, 1.4; 95% CI, 1.4-1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3-1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5-1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6-1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4-1.6) or >5 days (OR, 2; 95% CI, 1.8-2), and having private insurance (OR, 0.6; 95% CI, 0.6-0.7). Conclusions The 30‐day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk‐stratification models to reduce the high burden of readmissions. / Revisión por pares

Each year in the United States, thousands of people are readmitted within 30 days of being discharged from a hospital. Current research indicates that at least one-third of these rehospitalizations are preventable. The purpose of this project was to examine patient and environmental characteristics of those who were readmitted within 30 days of discharge for commonalities that may explain the gap in practice for a specific health care organization. The project was undertaken in response to the organization's need to improve a 50th-percentile ranking with the goal of reaching the top 10th percentile. A plan-do study-act framework was used as a guide to ensure no steps in the process were missed and the logical progression of the project was clear. Three fiscal quarters of data, including 515 readmissions, were examined. A data analytics cube on hospital-wide readmissions provided patient and environmental characteristics that were charted using common language for sorting purposes. Data analysis revealed that 77% of patients were admitted within 30 days of discharge with a diagnosis that differed significantly from the index admission. Potential gaps in practice identified were a need for more patient and family engagement and education by nursing during the inpatient stay in regard to the primary admitting condition, the management of comorbidities, and potential posthospital complications. Need exists for more intense whole-patient monitoring, communication, and education following the transition from hospital to home. A reduction in 30-day readmissions can reduce the psychological and physical burden on patients and families, on health care resources that could be used for other purposes, and on society in the form of financial costs that continue to rise.

Information from anecdotal interviews at a practicum site indicated a lack of training for advanced practice providers (APPs) in core competencies critical for effective practice in a heart failure (HF) unit. The goal of this project was to assess the APPs' verbal reports and develop HF unit-specific training for APPs. The practice-focused question examined whether unit-specific training for HF APPs improved knowledge and skills in HF management. The Johns Hopkins nursing evidence-based practice model and Knowles's adult learning theory were used to create a survey, a focus group, and a pre/posttest assessment of knowledge and skills gap. Descriptive and inferential statistics could be used to analyze pre/post survey data, and thematic analysis could be used to analyze focus group data. Assessment data could be used to develop a targeted HF program based on identified skill deficiencies. The implications of this project related to social change are the potential to increase APPs' knowledge, job engagement, and retention. The program could affect length of stay and 30-day readmission of patients in the HF unit.

Heart failure is a complex heart disease that incapacitates more than 5 million people, is associated with increasing healthcare cost, and remains the leading cause of admission in the United States. As the United States faces increasing financial burden related to readmission of heart failure patients within 30 days of discharge, many healthcare institutions are evaluating interventions to determine the most effective opportunities to improve systems, including nursing practice. The purpose of this doctoral project was to improve readmission rates within 30 days of discharge from an acute care facility through the development and implementation of a standardized, evidence-based, patient-centered discharge education toolkit using the Teach-Back method. Orem's self-care theory and the situation-specific theory of heart failure self-care were utilized as a theoretical framework to inform this doctoral project. The sources of evidence were obtained from the Get With The Guidelines-Heart Failure database and through a review of nursing and health-related databases. Descriptive statistics were used to compare the pre- and posteducation session readmission rates. The rate of readmissions occurring within thirty days of discharge pre- and post-educational session retrieved from the GWTG-Heart Failure database were 9.4% and 0.0% respectively. These results showed that this discharge toolkit reduced heart failure 30-days readmission rates. The limitations and strengths of this project will be used to guide further research on heart failure readmission and self-care management. This DNP project will promote positive social change for clinicians, who can use this discharge toolkit to improve self-management in adults with heart failure and thus decrease the costs related to readmission.

Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for implementation. A retrospective chart review was conducted of transitional care management and care coordination practices of providers of patients diagnosed with COPD. Analysis of the data revealed that the local regional organization used a single, generic, computerized discharge planning and care transition process for patients diagnosed with COPD. As a result, missed opportunities to target a patient's specific care needs led to higher rates of readmission. The implications of the findings of this project for social change include identification of evidence-based recommendations and practices that could influence clinician practices and improve patient outcomes and the quality of health care delivery.