Background This study assessed the impact of infectious diseases consultation (IDC) on 30-day readmission rates in patients with Staphylococcus aureus bacteremia (SAB). Furthermore, this study also evaluated the effect of IDC on adherence to guideline-directed therapy. Methods This retrospective cohort study enrolled 149 adult patients with SAB. Cohort 1 included 28 patients without IDC. Cohort 2 included 121 patients with IDC. Primary end point was all-cause 30-day readmission rates. Secondary outcomes included adherence to guideline-directed therapy and hospital length of stay (LOS). Guideline-directed therapy included repeat blood cultures until blood sterility, assessment for an echocardiogram, and appropriateness of antimicrobial therapy (including antibiotic, dose, and duration). Results Readmission rates were 46.4% (13/28) without IDC and 19% (23/121) with IDC (P = 0.006). Guideline-directed therapy occurred in 21.4% (6/28) without IDC versus 96.7% (117/121) with IDC (P = 0.0001). The average LOS was shorter without IDC than with IDC (5.6 vs 7.8 days, respectively; P = 0.01). The most common reasons for lack of guideline adherence in the control group were lack of echocardiogram (72.4%) and lack of repeat blood cultures (51.7%). Multivariate analysis demonstrated that only lack of IDC significantly affected readmission rates (odds ratio, 3.51; 95% confidence interval, 1.48-8.52; P = 0.0048). Conclusions Consultation with infectious diseases reduces 30-day readmission rates in patients with SAB and increases adherence to guideline-directed therapy; however, LOS was increased. Infectious diseases consultation should be considered for all patients with SAB.

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Hospital readmission rates are being used to indicate quality of care by healthcare facilities in recent years. Increase in incidence and hospitalizations of patients with diverticular disease (DD) has caused burden to hospital resources. High fiber diets have been a part of the recommended therapy for patients to reduce symptoms and complications of DD. Analysis of the effect of high fiber diet education on hospital readmission of patients with a diagnosis of DD (N=68) was conducted. Chi-square analysis determined that high fiber diet education was not associated with readmission (x2=0.567, P=0.452). T-tests determined that men were more likely to be readmitted than women (P=0.029). A higher BMI was also observed in patients who were readmitted compared to those not readmitted (P=0.006). While high fiber diet education was not associated with readmission, males and patients with a higher BMI were significantly associated with hospital readmission.

The transition after hospitalization is a vulnerable period when adverse events like unplanned readmissions may occur. Unplanned readmissions with patients undergoing chemotherapy that are the result of gaps in communicating the discharge plan may be preventable. Several transitional care interventions have been explored, and one of these is the nurse discharge phone call. This project explored the effect of a nurse-led transitional discharge phone call within 30-days after hospital discharge on unplanned readmission due to chemotherapy among patients in the medical-oncology compared to patients without a nurse-led transitional discharge phone call. A nurse-led transitional discharge phone call was implemented within 48 to 72 hours after discharge from the medical-oncology unit of a hospital in the northeastern region of United States to determine its effectiveness in reducing the number of unplanned readmissions due to chemotherapy. The Donabedian model, the Iowa model of evidence-based practice to promote quality care, the diffusion of innovation theory, and the health belief model served as the theoretical underpinnings of the project. Seven patients undergoing chemotherapy received the discharge phone call, and none were readmitted due to cancer-related complications. The unplanned hospital readmission rate was 0% compared to the 14.17% in 2017. The findings of this project might contribute to positive social change by helping the community of patients on chemotherapy to have a better transition process through acquiring necessary information for their postdischarge care and thus mitigating the possible causes of unplanned hospital readmission.

Every year, thousands of congestive heart failure (CHF) patients are readmitted to the hospital within 30 days of discharge. There is a gap in practice in the care continuum of patients with CHF within the transition from hospital to home. One of the factors known to increase a patient's risk for readmission is the lack of patient engagement and self-efficacy regarding the treatment plan. The purpose of this project was to implement a transition of care practice guideline that consisted of the use of a risk identification tool, a customized care plan for patients at high risk for readmission, and a discharge checklist crafted specifically for CHF patients who are at risk for readmission. The practice initiative utilized the Iowa model of Evidence Based Practice as a framework and the teach-back method for discharge education. A sample of 193 patients admitted during a 1-month timeframe fit the inclusion criteria and was generated from the electronic health record. Descriptive statistics were used to analyze the data collected during implementation. In fact, of the 106 CHF patients who benefited from the CHF checklist only 2 required readmission within 30 days, a 1.8% 30 day readmission rate. As compared to the 22% readmission rate experienced in 2017, this represented a considerable improvement, albeit preliminary. Efforts to improve the lives of patients and their families will ultimately serve society well, making a significant contribution to positive social change. Providing comprehensive discharge education to patients using the teach-back method to assess the retention of knowledge will help close the gap in the transition of care between hospital and home, ultimately reducing CHF readmissions.

Heart failure (HF) is one of the main reasons for hospitalizations and readmissions. A local hospital collaborated with a skilled nursing facility (SNF) in 2012 with the goal of reducing systolic HF readmissions. This collaboration consisted of having an Advanced Practice Nurse (APN) who specializes in cardiac care follow up with all patients discharged from the hospital to the SNF with a diagnosis of systolic HF. The practice-focused question for this project addressed whether early follow-up and continuity of care by a cardiac APN would decrease hospital readmission within 30 days in patients with systolic HF who are discharged to a SNF. This project evaluated the effectiveness of this intervention using the Donabedian quality framework. The Donabedian quality framework consists of 3 concepts: structure, process, and outcome. Sources of evidence were obtained through the electronic medical record systems at both facilities. Total of 1,009 patients were seen by the cardiac APN from 2012 to 2016. Results showed a steady decline in readmissions from 47% to 6%. This supported the conclusion that collaboration between hospitals and SNFs post hospital discharge is essential to improve the management and readmissions of HF. Specialized APNs, such as the cardiac APN in this study, may be more effective in the management and coordination of care for a specific patient population. Implications of this successful collaboration include better working relationships between nonaffiliated health care facilities, improved patient care outcomes, decreased readmissions for HF patients, and an improved community health care system.

Heart failure (HF) patients are among the populations with the highest rates of hospital readmission within 30 days of discharge. Because of the 2010 Health Care Reform legislation, healthcare organizations are subject to financial penalty when a patient population exhibits excess readmissions. A significant reason for readmission of HF patients is a gap in the transition of care from hospital to home. The purpose of this doctoral project was to develop a practice guideline of best practices for transitioning HF patients from hospital to home. The transitional care model and care transitions intervention provided the theoretical underpinnings for developing this project. The research question explored whether a transition-of-care guideline would reduce hospital readmission for the HF population. The methodology used to develop the clinical practice guideline was derived from a synthesis of scholarly literature and evidence-based transitional care quality initiatives. Seven interdisciplinary experts involved in HF transition of care used the Appraisal of Guidelines Research and Evaluation II instrument (AGREE II) to assess the development of the practice guideline. The scores of 6 AGREE II domains were summed and scaled to obtain a percentage of the maximum possible score for each domain. Scores showed that the clinical practice guideline was rigorous, high quality, effective in improving transition of care, and has the potential to reduce HF readmission. Positive social changes resulting from this practice guideline include an improvement in patient outcomes, a reduction in readmission rates, and a reduction in the associated financial burden to the hospital.

The purpose of this research is to inform the understanding of mental health readmissions by identifying associations between individual and environmental attributes and readmissions, with consideration of the impact of time-to-readmission within the Veterans Health Administration (VHA). Mental illness affects one in five adults in the United States (US). Mental health disorders are among the highest all-cause readmission diagnoses. The VHA is one of the largest national service providers of specialty mental health care. VHA's clinical practices and patient outcomes can be traced to US policy, and may be used to forecast national outcomes should these same policies be implemented nationwide. In this research, we applied three different data mining techniques to clinical data from over 200,000 patients across the VHA. Patients in this cohort consisted of adults receiving VHA inpatient mental health care between 2008 and 2013. The data mining techniques employed included k-means cluster analysis, association-rule mining, and decision tree analysis. K-means was used during cluster analysis to identify four statistically distinct clusters based on the combination of admission count, comorbidities, prescription (RX) count, age, casualty status, travel distance, and outpatient encounters. The association-rule mining analysis yielded multiple frequently occurring attribute values and sets consisting of service connection type, diagnoses/problems, and pharmaceuticals. Using the CHAID algorithm, the best decision tree model achieved 80% predictive accuracy when no readmissions were compared to 30-day readmissions. The strongest predictors of readmissions based on this algorithm were outpatient encounters, prescription count, VA Integrated Service Network (VISN), number of comorbidities, region, service connection, and period of service. Based on evidence from all three techniques, individuals with higher rates of system-wide utilization, more comorbidities, and longer medication lists are the most likely to have a 30-day readmission. These individuals represented 25% of this cohort, are sicker in general and may benefit from enrollment in a comprehensive nursing case management program.

Dans l’Union Européenne, la Commission prépare une réforme de la législation applicable en matière d’immigration et d’asile, face à une montée continue du nombre des immigrés et de demandeurs d’asile. Les difficultés économiques, sociales et politiques que rencontrent un grand nombre d’Etats des continents africain, asiatique et même européen, maintiendront une demande forte d’entrée d’étrangers. Cette situation confrontera l’U.E à la recherche d’un difficile équilibre entre les intérêts nationaux et un certain devoir d’assistance. Ainsi, y’a-t-il une protection suffisante pour les étrangers dans le droit de l’U.E ? Ensuite, y a t-il, un statut général applicable à tous les étrangers ? Il est à noter que les droits des étrangers sont à la fois limités et variables. Limités lorsqu’on confronte le statut des étrangers et celui des citoyens européens ; variables dans la mesure où les étrangers ne se voient pas tous reconnaître les mêmes droits. Ainsi, on estime que l’Union devrait élaborer une politique de migration plus proactive axée sur la gestion et non sur la prévention des mouvements migratoires. Cette politique devrait se fonder sur un cadre définissant clairement les droits des étrangers. Elle devrait garantir aux travailleurs migrants un cadre juridique en matière d’égalité de traitement avec les nationaux. Un cadre commun devrait être élaboré pour les conditions d’entrée et de résidence, à partir d’un consensus entre les pouvoirs publics et les partenaires sociaux concernant les besoins du marché du travail. / In the European Union, the Commission prepares a reform of the legislation on immigration and asylum, vis-a-vis a steady rise in the number of immigrants and asylum seekers. The economic, social and political difficulties, that a large number of States in Africa, Asia and even Europe encounter, will maintain a strong request for entry from abroad. This situation will confront the E.U in search of a difficult balance between the national interests and a duty of care. Thus, is there a sufficient protection for the foreigners in the European Union Law ? Then, is there a general status applicable to all the foreigners ? It should be noted that the rights of foreigners are at the same time limited and variable. Limited when one confronts the status of foreign and that of the European citizens; and variables to the extent that foreigners are not given all the same rights. Thus, it is estimated that the Union should develop a more proactive migration policy based on the management and not on the prevention of the migratory movements. This policy should be based on a clear framework of the aliens ‘rights. It should guarantee to migrant workers a legal framework as regards equal treatment with the nationals. A common framework should be developed in the conditions of entry and residence, starting from a consensus between the public authorities and the social partners concerning the needs of the labor market.