Transitional Care Intervention to Reduce 30-day Readmission Rate in Cardiac Transplant Patients
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Readmission remains a financial burden in our healthcare arena. Billions of dollars in hospital payments were made from Medicare towards readmissions. The problem of patients’ ineffective transitions during hospital discharge leads to an increased readmission rate. The purpose of the pilot study was to examine the effectiveness of the transitional care interventions during post hospitalization in reducing 30-day readmission rate in cardiac transplant patients. The quasi-experimental study used a retrospective group (baseline, usual discharge care) and a prospective group who received the transitional care interventions. The study was implemented in an outpatient medical center in New York City. The convenience consecutive sampling size was 43 participants. The transitional care interventions consisted of four components conducted by the advanced practice registered nurse: (1) meeting with the participants at the hospital, (2) facsimiles of discharge summaries, (3) scheduling a follow-up appointments, and (4) telephone call follow-up for 30 days post hospital discharge. The intervention group had a 30-day readmission rate of 8.3% (2/24) compared to 36.8% (7/19) in the usual group. The results indicated a significant decrease in the 30-day readmission rate among cardiac transplant patients who received the transitional care interventions (p=0.03). In the intervention group, transitional care provided the cardiac transplant patients with smooth, safe, and efficient transitions from hospital to home which can reduce the 30-day readmission rate. The transitional care intervention program can improve safety and quality of care in the healthcare system.
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