Date of Award

Spring 5-24-2019

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Joesph Burkard, DNSc, CRNA

Second Advisor

Homira Feely, DNP, NP-C

Abstract

Reducing ED Re-admissions in Post-Op Neuro Patients utilizing a NP Telephone Follow-up Protocol

Background

Post craniotomy patients discharging from the hospital to home, commonly present to the emergency department (ED) with incisional concerns. Complaints stem from minimal post-op education, poor incision management, and lack of knowledge relational to infection. Unanswered questions prior to discharge lead to unnecessary ED visits, anxious calls after discharge, and poor patient satisfaction. ED admissions lead to fortuitous costs that can be prevented through evidenced based interventions.

Purpose/Aim

Post craniotomy patients at a large hospital system in Southern California will have decreased ED visits correlated to their incision and phone calls, as a result of education and follow up phone calls.

Description of the Innovation

A small team of healthcare providers led by an advanced practice nurse will: (a) educate patients in the pre-surgical setting on expectations before, during and after brain surgery; (b) written education materials on infection symptoms; and (c) making telephone calls to patients at 24 and 72-hours post discharge. Phone call conversations are guided by an evidenced-based standardized questionnaire while employing the 5 A’s Behavior Change Model.

Outcomes

The goal is to achieve a 25% reduction in patients’ post-discharge ED visits and 30% reduction in patients’ calls during the three-month project period, compared to the three months prior to implication of project.

Implications

Improved pre-operative education along with well-timed post-discharge phone calls will reduce ED visits, patients’ calls, and improve satisfaction. The monetary costs will be monumental to the hospital and resources will be better used.

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