Barriers to Transition of Care for Heart Failure Patients

Barriers to Transition of Care for Heart Failure Patients by Catherine Murray MSN/ED, University of Phoenix, 2006 BSN, Saginaw Valley State University, 1987 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2017 Abstract Heart failure (HF) is an escalating chronic disorder that impacts patients, families, and society. HF necessitates efficient transition of care and complex self-care knowledge in a population often burdened with low health literacy and high readmission rates. The purpose of this project was to improve transition of discharged HF patients from a Level 1 trauma system in a mostly rural area of South Carolina to its affiliated nurse-led HF clinic. The no-show rate for initial visits to the health care system’s outpatient HF clinic by postdischarge patients was 59%. Using Henderson’s need theory and Stevens’s knowledge transformation model for theoretical guidance, a quality improvement project was conducted to identify factors related to no-show behavior in initial HF clinic visits using a retrospective chart audit of the first 50 no-show patients in a 90-day period. Data were collected from the electronic medical record and analyzed through descriptive statistics. Frequently noted factors were lack of literacy screening, use of assistive devices, and access issues related to distance to travel and transportation to the HF clinic. Recommendations included mandatory literacy level screening on admission, integration of an evidence-based health literacy screening tool into the electronic record, use of satellite HF clinic services, and consideration of a mobile HF clinic on wheels to better serve the rural population. Social change is expected to occur in this vulnerable population through these efforts to address health literacy issues and increase access to clinic care after hospital discharge.Heart failure (HF) is an escalating chronic disorder that impacts patients, families, and society. HF necessitates efficient transition of care and complex self-care knowledge in a population often burdened with low health literacy and high readmission rates. The purpose of this project was to improve transition of discharged HF patients from a Level 1 trauma system in a mostly rural area of South Carolina to its affiliated nurse-led HF clinic. The no-show rate for initial visits to the health care system’s outpatient HF clinic by postdischarge patients was 59%. Using Henderson’s need theory and Stevens’s knowledge transformation model for theoretical guidance, a quality improvement project was conducted to identify factors related to no-show behavior in initial HF clinic visits using a retrospective chart audit of the first 50 no-show patients in a 90-day period. Data were collected from the electronic medical record and analyzed through descriptive statistics. Frequently noted factors were lack of literacy screening, use of assistive devices, and access issues related to distance to travel and transportation to the HF clinic. Recommendations included mandatory literacy level screening on admission, integration of an evidence-based health literacy screening tool into the electronic record, use of satellite HF clinic services, and consideration of a mobile HF clinic on wheels to better serve the rural population. Social change is expected to occur in this vulnerable population through these efforts to address health literacy issues and increase access to clinic care after hospital discharge. Barriers to Transition of Care for Heart Failure Patients by Catherine Murray MSN/ED, University of Phoenix, 2006 BSN, Saginaw Valley State University, 1987 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2017 Acknowledgments I want to thank my husband, Ken, my son, Gerald, and my chair, Dr. Bell, for their support and patience.