Applying STAAR interventions in incremental bundles: improving post-CABG surgical patient care.
BACKGROUND
Rehospitalization within 30 days of discharge after coronary artery bypass surgery (CABG) is a contributing factor to higher-than-acceptable overall hospital readmission rates throughout the United States. CABG rehospitalizations are of such concern that they are specifically targeted for action in 2015 under the Patient Protection and Affordable Care Act (2010). The phenomenon of increasing readmission rates has prompted the Institute for Healthcare Improvement to devise the Triple Aim initiative and the STate Action on Avoidable Rehospitalizations (STAAR) initiative to reduce 30-day readmission rates nationally.


OBJECTIVE
This study explored the impact of implementing STAAR interventions delivered as part of a quality improvement project in incremental bundles on 30-day readmission rates and the experience of care in CABG patients. Specifically, the use of the teach-back patient education method and the scheduling of follow-up cardiology appointments prior to discharge using existing staff were examined.


METHODS
A quantitative comparative study was conducted with 189 post-CABG patients at a tertiary care facility in the United States over a 2-year period, comparing outcomes between the group of patients prior to implementation of the STAAR interventions and those who later received them. Outcome variables included 30-day readmission rate and patient perception of experience of care.


RESULTS
The overall 30-day readmission rate for CABG patients in the postintervention group was decreased to 12.0%, compared to 25.8% in the preintervention group. Of the demographic and health characteristics explored, only chronic lung disease was significantly related to 30-day readmission rates, and only in the postintervention group.


CONCLUSIONS
Thirty-day readmission rates among CABG patients can be reduced and the experience of care can be enhanced through the use of targeted interventions utilizing existing staff and resources. The deliberate incremental implementation of bundled initiatives is an effective strategy in reducing 30-day readmissions in post-CABG patients.
Administrator, Senior VP Patient Care Continuum and CNO, Allegiance Health, Jackson, MI.
Ondrea L
OL
Bates
Nancy
N
O'Connor
Deborah
D
Dunn
Susan M
SM
Hasenau
D000368:Aged; D001026:Coronary Artery Bypass / Q000451:nursing*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D058991:Patient Protection and Affordable Care Act; D010359:Patient Readmission / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D016528:Postanesthesia Nursing / Q000592:standards*; D019984:Quality Indicators, Health Care; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014481:United States
STAAR; incremental bundle; patient education; post-CABG; readmission; surgical care