Date of Award

Spring 5-28-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Joseph Burkard, DNSc, CRNA, AACN Health Policy Fellow

Second Advisor

Jeana Jones, RN

Third Advisor

James Hwang, MD

Abstract

Background: Patients age 65 and older are identified as being an at-risk population for readmissions to the hospital within 30 days. Evidence based practice has shown that completing the Identifying Seniors At Risk (ISAR) screening tool can help to identify the needs of these patients so they can age in place at home with the proper resources. The screening tool consists of 6 questions. A score of 3 or more on the ISAR is deemed high-risk and a consult with case management should be considered. The average completion rate in an emergency department was identified as being 33%. The goal of this project was to increase nurses completing the ISAR screening tool to 80% in the emergency department for these patients.

Methods: An in-service education on what the ISAR screening tool is and the importance of completing the screening tool to improve patient outcomes was done. Data was collected for three months prior to the in-service and data was collected for two months post in-service. The data included the average completion rate of the screening tool. Education was provided to all new employees during that time period, or those that returned to work after an extended period of time.

Results: For three months (August – October) it was identified that the average completion rate of the ISAR screening tool was 33%. An in-service was provided to staff during the last 2 weeks of October. The two months post in-service (November – December), the average completion rate increased to 45%.

Conclusions: Although positive results were shown in the data collected, barriers related to the pandemic limited this project to reaching its goal. Given that there was an increase in completion rates, it is recommended that additional data be collected when barriers related to pandemic subside. Once the completion rate is maintained, this project can be continued by tracking the number of readmissions post intervention.

Implications for Clinical Practice: Improves patient outcomes and allows for hospital to advocate for this high-risk population to age in place at home. The goal of completing ISAR is to reduce preventable hospital readmissions within 30 days of discharge. By decreasing preventable hospital readmissions it can decrease penalties which allow the opportunity for the hospital to provide more resources for high-risk patients.

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