EBP Project Abstract
Appraised by: (Elizabeth Sam, Samira Roble, Alexis Griffin )
Clinical Question:
For chronically ill patients over the age 65 years and older, does the use of telehealth reduce hospital readmission rates?
Articles:
McManus, S. G.(2004). A telehealth program to reduce readmission rates among heart failure patients: one agency’s experience. Home Health Care Management & Practice, 16(4), 250-254. http://dx.doi.org/10.1177/1084822303262542
Riegel, B., Carlson, B., Kopp, Z., LePeti, B., Glaser, D., & Unger, A. (2002). Effect of a standardized nursing case-management telephone intervention on resource use in patients with chronic heart failure. Archives of Internal Medicine, 162,(6), 705-712. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000779-200203250-00013&LSLINK=80&D=ovft
Sorknaes, A. D., Madsen, H., Hallas, J., Jest, P., & Hansen-Nord, M. (2010). Nurse tele-consultations with discharged COPD patients reduce early readmissions - an interventional study. The Clinical Respiratory Journal, 26-34. http://dx.doi.org/10.1111/j.752-699X.2010.00187.X
Synthesis of Evidence:
Reigel, et al. (2002) and Sorkneas, et al. (2010) had large sample sizes which allowed for statistically significant results. McMannus (2004) was a small sample size group, but also provided significant results supporting the use of telehealth. All three articles supported the use of telehealth and showed a decrease in readmission rates within 30 days to the hospital after initial discharge with a chronic disease (COPD, cancer, CHF). Satisfaction of the telehealth program use was high in the intervention groups and healthcare providers of all three articles. All three articles provided a good description of telehealth, its functions and how it was integrated into home health services. Further research is suggested in the use of telehealth in different populations, larger randomized patient sample sizes and non-randomized physician participation.
Bottom Line: (findings)
The evidence suggests the use of telehealth services can decrease readmission rates to the hospital for chronically ill patients over the age of 65 years.
Implications for Nursing Practice:
Nurses can provide real-time interventions to patients based on vital signs and symptom management. If using telehealth as an extension of home health services, patients have the ability to work with their medical providers using telephonic or video communication on a daily basis. Based on the patient’s symptoms, the nurse can provide early interventions by using her critical thinking and case management skills.