The relationship between discharge clinical characteristics and readmission in patients hospitalized with heart failure
Heart failure is a clinical syndrome that incurs a high prevalence, mortality, morbidity and economic burden in our society. Patients with heart failure may experience hospitalization due to an acute exacerbation of their condition. Recurrent hospitalizations soon after discharge are an unfortunate occurrence in this patient population. This study explores the clinical characteristics of respiratory status, volume status and functional status at hospital discharge and the correlation of these characteristics to 60-day heart failure readmissions. The study is a descriptive, correlational, quantitative study utilizing a retrospective review of 134 medical records of individuals discharged with a primary diagnosis of heart failure from January 2006 through December 2007. Records were reviewed for socio-demographic characteristics, health histories, clinical assessment findings, diagnostic information, and nursing sensitive indicators. The determination of nursing sensitive indicators is based upon literature review and theoretical considerations regarding the key factors related to readmission. Significant predictors of 60-day heart failure readmissions were dyspnea (B=.579), crackles (B=1.688) and assistance with activities of daily living (B=2.328), independent of age and gender. By using hierarchical logistical regression a model was derived which demonstrated the ability to correctly classify 77.4% of the cohort; 78.2% of those who did have a readmission (sensitivity of the prediction) and 76.7% of the subjects where the predicted event, readmission, did not occur (specificity of the prediction). Hospitalizations for heart failure are markers of clinical instability. Future events after hospitalization are common in this patient population and this study provides a novel understanding of clinical characteristics at the time of discharge that are associated with future outcomes, specifically 60-day heart failure readmissions. This study adds to our understanding of the contribution nursing sensitivive indicators make to the risk of readmission in patients admitted to the acute care setting with a primary discharge diagnosis of heart failure. A consideration of these characteristics provides an additional perspective to guide clinical decision making and the evaluation of discharge readiness. Along with determining readiness for discharge, an appreciation of clinical dishcarge factors provides a representation of clinical stability which has implications for post-hospitalization care and monitoring.
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