Using CDUs to Reduce Readmissions

Clinical decision units (CDUs) are promising, say researchers Jo Ellen Carpenter, DNP; Nancy Short, DrPH; Tracy E. Williams, DNP; Ben Yandell, PhD; and Margaret T. Bowers,DNP—even though preliminary data from their CDU-based intervention haven’t shown the results they expected.

Related: Heart Failure Readmissions? Suspect Senile Amyloidosis

Based on evidence from disease management and patient education studies, reports on the use of predictive index tools, and observations of a successful CDU/congestive heart failure (CHF) clinic ; at Piedmont Hospital in Atlanta, Georgia, the hospital agreed to a CDU project to improve care and reduce the overall 30-day readmission rate for patients with CHF at Norton Audubon Hospital in Louisville, Kentucky.

Related: Factors Affecting Heart Failure Readmission Rates in VA Patients

Multidisciplinary teams (with a 1:5 RN-to-patient ratio) used evidence-based nursing interventions, including predictive index–guided discharge plans, with additional assessment if the patient was a mitigated 30-day readmission or was identified as high risk. Assessments included follow-up appointments, adherence to medication regimen, and home services.

The numbers went up slightly, from 21% readmission rate before the project to 23% after the project. By comparison, the comparison hospital (also caring for tertiary-level cardiology patients within the Norton system) showed a decline, from 26% to 17%.

Those immediate findings were somewhat disappointing, but they have not daunted the researchers, who say, first, that “due to the lagging nature of the data” more time is needed to see the real numbers and, second, that the hospital is pleased with the overall approach. Costs are being reduced, which “will strengthen the ability for the facility to continue CDU operation and allow time for care processes to mature.” And patients are satisfied with their care experience, according to discharge phone calls.

Related: PTSD Increases Chance of Heart Failure

Readmission rates in hospitals are a “complex phenomenon not easily impacted by singular interventions like a CDU,” the researchers say. Their plan is to continue to maintain a cardiac focus while they duplicate the CDU concept in another system hospital. “Organizational support,” they report, “is strong.”

Source: Carpenter JE, Short N, Williams TE, Yandell B, Bowers MT. Nurs Econ. 2015;33(5):255-262.