Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Lynne Jensen

Clinical Mentor

Dr. Jo Singleton

Committee Member

Dr. Julie Ossege

Abstract

PURPOSE: The purpose of this study was to evaluate the impact of a registered Nurse Navigator (NN) on hospital 30-day readmissions for patients with heart failure at Norton Healthcare (NHC) in Louisville, Kentucky.

METHODS: This study involved two phases. Phase I was a retrospective descriptive design utilizing a medical record review of 159 patient charts. Group 1, 54 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses and were seen in a primary care clinic that utilized a NN after discharge from the hospital. Group 2, 105 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses who were seen in a primary care practice that did not utilize a Nurse Navigator after discharge from the hospital. The medical records reviewed included heart failure discharges from NHC facilities that took place between June 1, 2015 to May 31, 2017.

Phase II was a focused interview with seven Norton Community Medical Associate (NCMA) Nurse Navigators. The interviews were used to gain, from a Registered Nurse Navigator, perspective into why 30-day readmissions are occurring and effective strategies to prevent 30-day readmissions.

RESULTS: There was no statistically significant decrease in hospital readmission among those who were called by a NN and those who were not called by a NN (p=.22, see Table 2). There was no statistically significant difference in rehospitalization between patients followed by a NN versus no NN involvement. There was a trend in decreased rehospitalization rates in patients followed by a NN.

CONCLUSION: The Nurse Navigator program demonstrated a trend toward decreased 30-day hospital readmission. The Nurse Navigator identified interventions such as NHC’s Heart Failure clinic, daily weight management, primary care provider (PCP) follow-up, and home health to improve patient self-management of heart failure. The NN program did not show statistically significant results, but the trends in hospital readmission for the group that received a NN call versus the group that did not receive a NN call show improvement.

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