This document discusses reducing hospital readmissions and improving quality of care. It identifies several key causes of hospital readmissions, including non-compliance with treatment plans, inappropriate transition from hospital to home, complex medical conditions, and medication errors. The document evaluates different solutions to reducing readmissions, including patient segmentation, improving care transitions, reducing errors, and ensuring adequate staffing. It determines that ensuring adequate and competent hospital staffing is the best option to improve quality of care and reduce preventable readmissions in an ethical manner.

1. MSN 5650 Reducing Hospital Readmission And Improving Quality
MSN 5650 Reducing Hospital Readmission And Improving QualityMSN 5650 Reducing
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REDUCING HOSPITAL READMISSION Reducing Hospital Readmission and Improving
Quality of Care Alain Leon Anaelis Travieso Andres Pareja Dagmara Lima Eduardo Gonzalez
Mailin Quinones Michel Gonzalez Reinel Romero Salvador Sanchez Yaima Hernandez
Yarisvey Mendoza Miami Regional University MSN5650 Nursing Decision Making Dr. Idania
Martin, DNP, APRN, ANP-BC 1 REDUCING HOSPITAL READMISSION 2 Reducing Hospital
Readmission and Improving Quality of Care Hospital readmission rates are the most-cited
indicators of establishing the quality of services offered by healthcare facilities. Although
readmission is a widely used term, it lacks a standardized and universal time frame for
reporting cases as readmissions by Yu, Mamey, and Russell (2017). Some healthcare
facilities and organizations have their readmissions’ interpretations from 24 hours to 1 year
upon discharge from a facility (Hughes & Witham, 2018). The absence of uniform criteria
makes the term confused with other related terms, such as rehospitalization and
unscheduled admissions. However, most healthcare facilities view readmission as any case
in which a patient is brought back to a hospital for the same or related causes 30 days after
discharge (Hughes & Witham, 2018). Diseases and sicknesses that result in readmission
may be the same or similar to the previous cases in which patients received medication.
MSN 5650 Reducing Hospital Readmission And Improving QualityThere are the increasing
cases of hospital readmission, most of them having a strong link to low quality of services.
According to El Morabet et al. (2018), three percent of patients visiting a hospital within 30
days are readmitted in the same or different facilities over cases related to the previous
health challenges. Kry?, ?yszczarz, Wyszkowska, and K?dzioraKornatowska, (2019),
reported a similar prevalence and stressed that at least three to 25 percent of readmission
cases refer to drug misdiagnosis and 30 percent of the cases reported are preventable. An
increase led to the development of readmission reduction programs by the Medicaid to
financially hospitals experiencing cases to enable them to improve the quality of services
they offer (Fonarow, Konstam, & Yancy, 2017). The initiative has helped in creating

2. interventions for the problem. Therefore, it is essential to look at the major causes of
hospital readmission and evaluate the available options to minimize the cases. REDUCING
HOSPITAL READMISSION 3 Ethical Decision-Making Process Description of the Problem
Patients expect to receive quality services upon visiting healthcare facilities, and it is the
role of healthcare practitioners to ensure the wellness of clients. Hospital readmission is
one of the challenges experienced in the health sector. Several causes attributed to hospital
readmissions. Disengagement and non-compliance, inappropriate transition procedures,
the complexity of conditions, and medication errors are the most cited reasons for the
increasing cases of readmissions (Fonarow, Konstam, & Yancy, 2017). In this connection,
one of the ethical considerations for healthcare facilities is to ensure addressing patients’
health needs, especially when the latter pay costly to access them. Another ethical
consideration is preserving human life by providing the best services to ensure patients’
wellness. Patient segmentation, improving transition systems, reducing medical errors, and
adequate staffing are some solutions to hospital readmission, with the latter being the most
effective strategy (Hughes & Witham,2018). MSN 5650 Reducing Hospital Readmission And
Improving QualityDiseases and sicknesses that result in readmission may be the same or as
the previous cases in which patients received medication. A large part of the growing cases
of hospital readmissions has a strong link to low quality of the services previously received.
Description of Ethical Considerations Several factors have cited as the root causes of
hospital readmissions. First, the complexity of conditions on the part of patients may
contribute to the cases of readmission (Sportsman, 2014). A significant portion of
individuals with severe conditions, such as pneumonia, kidney failure, sepsis, and heart
failure, report high cases of hospital readmission (Hughes & Witham,2018). These
conditions tend to develop abruptly regardless of the time a patient has taken after
discharge from the hospital. Franckowiak, Raub and Yost (2019) asserted REDUCING
HOSPITAL READMISSION 4 that some conditions might develop severe complications when
patients fail to adhere to the management practices recommended by physicians. These
arguments are in line with those by Ma et al. (2018), who stated that patients’ failure to
follow treatment schedules might complicate their conditions, thereby leading to
preventable readmissions. Ideally, practitioners and healthcare administrators must plan
hospital discharge and postdischarge processes effectively. Otherwise, an inappropriate
transition procedure may result in readmission cases (Sportsman, 2014). The transition
may include empowering patients on appropriate self-management practices they should
adopt upon leaving a facility. Also, medical practitioners are required to plan for home
visits, follow-up appointments, and ensure that patients have detailed, clear, and easy to
understand instructions (Jamei et al., 2018). Patients need to adhere to these instructions
for the realization of their desired wellness. It is an ethical requirement for the practitioners
to ensure that a positive transition of the patients from the facility to home-based care
(Franckowiak et al., 2019). They are also required to ensure that the patients’ environment
is not harmful since this is part of the nursing principles that require the nurses to avoid
harming the patients (Broadway, 2018). In this situation, harming may expose the clients to
the harmful environment, especially when referring them to home-based care. Patients
leaving a healthcare facility need to be aware of what they should do in managing their

3. conditions. Jamei et al. (2018) state that leaving a healthcare facility with piles of papers
where it is difficult to interpret information is one cause of hospital readmission. These
arguments are in line with the assertions by Yu, Mamey, and Russell (2017), who argue that
the unwillingness of the patients to adopt sound healthcare practices may be due to a
healthcare practitioner’s failure to give clear instructions on self-management practices. As
a result, clients make selfmedication errors that may compromise their wellness, thus
making them return to hospitals. REDUCING HOSPITAL READMISSION 5 Inappropriate
transition procedures result in the misinterpretation of discharge instructions. According to
Hughes and Witham (2018), many patients are readmitted to healthcare facilities due to a
failure to accurately interpret drug dosage instructions and other recommendations related
to healthcare practices. Ma et al. (2018) argued that non-compliance cases result from
patients’ unwillingness to participate in sound care practices. MSN 5650 Reducing Hospital
Readmission And Improving QualityHowever, Hughes and Witham (2018) disagreed with
these assertions and state that non-compliance results from a failure to interpret medical
instructions issued at medical facilities and not from a patient’s lack of knowledge. Most of
the patients opt to forego medications, especially when they fail to understand their
purpose, dosage, and mode of intake (Sportsman, 2014). The practitioners to have a
professional responsibility to explain to the patients the details related to each medication
prescribed. Also, medication errors have been cited as one of the significant causes of
hospital readmission. The quality of services offered in a healthcare facility depends on the
degree to which errors are minimized (Yoder-Wise, 2018). Several factors contribute to
medication errors. First, patients’ history may not be considered when making an
assessment and diagnosing their present conditions. A failure to conduct an in-depth
analysis of the present and past medical conditions may result in partial treatment of the
prevailing conditions, thereby resulting in future readmissions (El Morabet et al., 2018).
Errors may also result from inaccurate documentation of a patient’s data. There are
increasing cases of patients’ data being wrongly filed, lost, or used for another client (Yoder-
Wise, 2018). Nursing ethics require practitioners to refrain from harming patients.
Therefore, they are expected to carry out accurate diagnoses and adopt appropriate
treatment approaches likely to prevent harm to patients. According to Hughes and Witham
(2018), some medication errors REDUCING HOSPITAL READMISSION 6 originate from
nurses’ lack of knowledge or other medical practitioners. Some patients are harmed during
a treatment process, discovered later after discharged from a facility (Kry? et al., 2019). For
instance, there are cases when catheters are left in patients’ bodies after surgery. Such
errors may have devastating effects, which in turn results in readmission. It is an ethical
requirement for the practitioners to provide the best services to ensure the wellness of the
patients. A significant portion of medical errors is preventable, meaning that effective
medical procedures can help minimize readmission cases. It is ethical to ensure that the
services provided in the healthcare facilities are beneficial to the patients. The nursing
principles also provide that the services rendered to clients visiting the facility should be in
accordance with their medical conditions, and the health outcomes should be aligned with
the expected outcomes.. Understaffed healthcare facilities may not help in addressing these
ethical requirements. Inadequate amount of practitioners may not offer quality services

4. since they have diverted attention to which patients to serve at a particular time
(Sportsman, 2014). MSN 5650 Reducing Hospital Readmission And Improving QualityThe
hurried approach to treatment to attend to all patients may lead to a failure to meet clients’
needs. The nursing process is expected to be comprehensive, running from assessment,
diagnosis, plan, and interventions to recover the health wellness of every individual.
Evaluation of Solutions Several strategies can help reduce readmission cases in medical
facilities, as a need for medical practitioners to segment their patients based on the degree
of high risk to readmission. According to Hughes and Witham (2018), some facilities are
likely to report readmission cases than others. Mavrea et al. (2015), opined that it is
necessary to monitor individuals at high risk of hospital readmission and give them
exceptional quality services that could suppress conditions REDUCING HOSPITAL
READMISSION 7 to manageable levels that would not warrant hospitalization. This strategy
is in line with the medical ethics that require practitioners to provide quality services likely
to address the health needs of their clients. Shahida et al. (2016) argued that follow-up
plans and regular appointments should be incorporated into management plans after
patients are discharged from healthcare facilities. The plans would help in the realization of
comprehensive care for patients, aligned with ethical care practices in nursing. Close
monitoring and the provision of quality services may, therefore, minimize readmission
cases. The healthcare practitioners will be doing a beneficial action toward their patients
from the ethical point of view by helping the patients to understand the complexity of their
conditions and allowing them to participate in the strategies recommended to manage their
conditions and prevent reoccurrences. Those interventions could improve the quality of
care and may reduce the complications that bring the patients back to the hospitals
(Broadway, 2018). Additionally, there is a need for an adequate number of nurses and
physicians. This strategy is one of the most effective methods of improving the quality of
services and reducing readmission rates (Yoder-Wise, 2018). All healthcare facilities should
have adequate staffing, especially for nurses. The nurses are contact persons between
patients and physicians. It is thus very unlikely to deliver quality services in facilities having
a nurse shortage (Sportsman, 2014). A key component of ensuring adequate nursing
coverage should be offloading non-clinical activities from nursing staff to appropriate non-
clinical personnel, ensuring that clinical staff members can focus on patient care and
practice at the top of their license. When staff levels are higher, nurses may have: (1) more
time to spend with each patient, (2) a better documentation quality, (3) and reduced
opportunities for medical mistakes. Moreover, improving staffing, nurses could improve the
provider-patient/family communication REDUCING HOSPITAL READMISSION 8 and
provide assertive explanations of instructions during the discharge.MSN 5650 Reducing
Hospital Readmission And Improving QualityAll these actions related to higher nursing
staffing can help prevent hospital readmission down the road. Thus, the facilities need to
increase their staff to enhance quality service delivery, which is part of ethical measures to
be adopted in the hospitals. Regarding theclients’ medical information, the healthcare
facilities should guarantee that it will be securely stored to avoid the adverse medical
implications that come with the loss of the information and affecting the continuity of care
(Sportsman, 2014). The healthcare facilities should adopt electronic information systems to

5. record and store data and do on-job training to improve their staff’s competence. Choosing
a Solution The best alternative is ensuring that facilities have adequate and competent staff.
YoderWise (2018) asserts that adequate staff would help improve the quality of services
offered hence aligning with the ethical requirements that require facilities to ensure that
the patients receive satisfactory care. The quality of services in health facilities depends on
the extent to which available medical practitioners can comprehensively address the needs
of patients (Shahida et al., 2016). El Morabet et al. (2018) allude that readmission cases are
a result of the failure of the healthcare facilities to comprehensively address the health
needs of the patients and medical errors resulting from hurried treatment procedures.
Having enough personnel is also in line with the ethical workforce management practice
that requires organizations to have adequate staff to prevent cases of burnout, which may
compromise the health status of the existing employees (Sportsman, 2014). Therefore,
adequate staffing would ensure that every client is accorded due REDUCING HOSPITAL
READMISSION 9 attention while also minimizing the cases of prolonged waiting time
associated with hospitalacquired infections and subsequent readmissions. Implementing
the Solution The healthcare facilities need to ensure that each department has competent
practitioners. Also, those on transfers and resignations need to be timely replaced to reduce
staff shortage. An adequate number of staff members would also help in the comprehensive
assessment and diagnosing of patients to establish all underlying health challenges. MSN
5650 Reducing Hospital Readmission And Improving QualityThe analysis would then lead
to comprehensive care, which reduces the cases of partial treatments and their associated
readmissions. Therefore, employing an adequate and competent staff would reduce the
workload of the existing medical practitioners, thereby enhancing their good health
(Shahida et al., 2016). The evaluation of the solution should pay attention to establishing the
number of patients readmitted in the facility and their satisfaction levels. Increased levels of
patients’ satisfaction with the services offered and low rate of readmission cases would be
an indicator that the solution is effective in improving ethical standards in the hospitals.
Further investigations regarding other factors affecting the readmission will be needed to
correlate the potential decrease of the hospital readmission to the implemented measure.
Conclusion Hospital readmission occurs when patients are taken back to healthcare
facilities over cases similar to those previously treated within a short period. There are
several causes of hospital readmission, the most notable being disengagement and non-
compliance, inappropriate transition procedures, the complexity of conditions, medication
errors, and healthcare provider shortage. Addressing the problem would be in line with the
ethical principle of beneficence. The principle will be based on the benefit that s healthcare
facilities provide their clients’ by REDUCING HOSPITAL READMISSION 10 rendering the
best quality in their services, promoting wellness, and preventing the loss of life. Patient
segmentation, improving transition systems, reducing medical errors, and adequate staffing
are some solutions to the problem (Hughes & Witham, 2018). Adequate staffing may be the
most effective solution, considering that its implementation would mitigate other causes of
hospital readmission. The strategy also adheres to the ethical requirements of enhancing
the workforce’s welfare and patients in healthcare facilities. MSN 5650 Reducing Hospital
Readmission And Improving QualityREDUCING HOSPITAL READMISSION 11 References

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32. El Morabet, N., Uitvlugt, E. B., van den Bemt, B. J., van den Bemt, P. M., Janssen, M. J., &
Karapinar?Çarkit, F. (2018). Prevalence and preventability of drug?related hospital
readmissions: A systematic review. Journal of the American Geriatrics Society, 66(3), 602-
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(2017). The hospital readmission reduction program is associated with fewer readmissions,
more deaths: Time to reconsider. Journal of the American College of Cardiology, 70(15),
1931-1934. http://dx.doi.org/10.1016/j.jacc.2017.08.046 Franckowiak, T. M., Raub, J. N., &
Yost, R. (2019). Derivation and validation of a hospital allcause 30-day readmission index.
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