Passport to Your Heart Recovery

Project Topic:

Discharge education for cardiothoracic surgery patients

Hospital Unit(s):

Cardiac Progressive Care Unit

CSI Participants:

• Stacey Diaz, BSN, RN, PCCN
• Ivan Guarin, BSN, RN, PCCN

Project Goals/Objectives:

1. Decrease coronary artery bypass graft (CABG) patient readmission 3%
2. Increase nurse education HCAHPS score 5% for the question “During this hospital stay, how often did nurses explain things in a way you could understand?”
3. Implement a nurse survey comparing the old vs. the new discharge process

Project Outcomes:

1. Decreased CABG readmissions 7.1% (18.1% to 11%)
2. Increased HCAHPS score 2.8% for the question “During this hospital stay, how often did nurses explain things in a way you could understand?” (from 71.8% to 74.6%)
3. Increased nurse confidence in educating cardiothoracic surgery patients 11% (from 6.8 to 7.6 on a 10-point scale on pre- and post-project surveys)
4. These project outcomes resulted in an estimated annual fiscal impact of $129,593.

Project Overview:

Loma Linda University Medical Center (LLUMC) has experienced a steady rate of coronary artery bypass graft (CABG) readmissions. Data shows that the top reasons are:

1. Arrhythmia, congestive heart failure and pneumonia (7.91% each)
2. Pleural effusions (6.47%)
3. Stroke and sepsis (5.04% each)

Our CSI team also learned that our hospital’s HCAHPS score for the question “During this hospital stay, how often did nurses explain things in a way that you can understand?” ranked below the 75th percentile national benchmark.

In addition, cardiothoracic surgery patients are a new population for our Cardiac Progressive Care Unit since moving into a new hospital facility. A pre-project survey indicated that the average RN confidence level in educating these patients was 6.8 on a 10-point scale.

The central strategy of our CSI project was to create an easy-to-understand educational booklet (“passport”) of information for patients who are admitted for CABG. The purpose of the passport was to decrease readmission rates by providing education for our cardiothoracic patients and to increase the confidence level of nurses when educating those patients.

We started by conducting a pre-education survey for nurses. Then we developed a draft passport and reviewed it with cardiothoracic nurse practitioners, educators and managers. Next, the team launched conducted a kickoff _event where we educated the nursing staff about the passport and shared passport draft. Following the kickoff, we created an education point for patients’ electronic health record.

Several months after submitting the final passport draft for approval, our CSI team received printed passports to share with patients, and we started the process of translating the passport into Spanish. We also conducted a post-project survey for nurses to evaluate our passport and education for cardiothoracic patients.

We successfully reached our goal of decreasing the readmission rate (reduced 7.1%), which translates to projected fiscal savings of $215,984 for our hospital. We also were able to increase our HCAHPS score 2.8% for the question “During this hospital stay, how often did nurses explain things in a way you could understand?” What’s more, we were able to increase nursing confidence 11%, from 6.8 to 7.6 on a 10-point scale.

Feedback about our project has been overwhelmingly positive. Nurses expressed how easy it is to teach with this passport, especially having pictures to provide education visually. Patients said reading the passport helped them feel less anxious and answered a lot of questions they had about their surgery. To sustain our project, we plan to include the passport in our new hire orientation checklist, identify internal “champions” to encourage its use, and include it in our discharge tool checklist that nurses use when discharging a heart surgery patient.