The article “Preventing Rehospitalization by Bringing Primary Care to the Bedsid

The article “Preventing Rehospitalization by Bringing Primary Care to the Bedside” by Wingate et al. (2019) discusses a program to reduce rehospitalization rates by providing primary care services directly at the patient’s bedside. The authors outline the program’s structure and implementation, highlighting its potential benefits in improving patient outcomes and reducing healthcare costs. Feo et al. (2023) sought to investigate nursing and allied health professional perceptions of the inter-relationship between avoidable hospital readmissions and fundamental care delivery. They also hold to the view that avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals (2023). Previous studies have characterized readmissions following coronary artery bypass grafting (CABG) as a major clinical burden (Shah et al., 2019). 
Explanation of Literature Review Results: Through a literature review, we found that transitional care interventions, such as those discussed in the article, have effectively reduced hospital readmissions for various patient populations, including those with heart failure. Studies have shown that providing timely and comprehensive primary care during hospitalization and post-discharge can lead to better management of chronic conditions, improved medication adherence, and reduced likelihood of complications or exacerbations that may necessitate rehospitalization.
Connection to Practice Problem of Reducing Hospital Readmission for Heart Failure Patients: Heart failure patients are particularly vulnerable to hospital readmissions due to the complex nature of their condition and the need for ongoing monitoring and management. By bringing primary care services to the bedside, as proposed in the article, we can address the unique needs of heart failure patients during hospitalization and support their transition back to the community, ultimately reducing the risk of readmission.
Synthesis of Evidence for Practice Change: Based on the evidence from the literature review and the insights provided by the article, we propose the following practice change initiative:
Implementation of a Bedside Primary Care Program for Heart Failure Patients: This program will involve embedding primary care providers, such as nurse practitioners or physician assistants, within the cardiology or heart failure care team. These providers will assess patients’ primary care needs during hospitalization, provide preventive services and health education, optimize medication regimens, and coordinate post-discharge care with community-based primary care providers.
Focus on Patient Education and Self-management: Besides providing direct clinical care, the bedside primary care team will prioritize patient education on heart failure management, including symptom recognition, dietary and lifestyle modifications, medication adherence, and when to seek medical attention. Empowering patients to actively participate in their care can help reduce the likelihood of complications and readmissions.
Collaboration with Community Resources: Recognizing the importance of continuity of care beyond the hospital setting, the bedside primary care team will collaborate closely with community-based primary care providers, home health agencies, and other healthcare organizations caring for heart failure patients. This collaboration will facilitate seamless care transitions and ongoing support for patients post-discharge.
Need for Practice Change Initiative: The need for this practice change initiative is underscored by the high rates of hospital readmissions among heart failure patients and the evidence supporting the effectiveness of transitional care interventions in reducing readmission risk. By implementing a bedside primary care program tailored to the needs of heart failure patients, we can enhance the quality and continuity of care, improve patient outcomes, and reduce healthcare costs associated with preventable readmissions.
In summary, the synthesis of evidence from the literature review and the insights provided by the article support the implementation of a bedside primary care program as a practice change initiative to reduce hospital readmissions for heart failure patients. By addressing the primary care needs of patients during hospitalization and supporting their transition back to the community, we can make significant strides in improving care quality and outcomes for this vulnerable population.
References 
Feo, R., Urry, K., Conroy, T., & Kitson, A. L. (2023). Why reducing avoidable hospital readmissions is a ‘wicked’ problem for leaders: A qualitative exploration of nursing and allied health perceptions. Journal of advanced nursing, 79(3), 1031–1043. https://doi.org/10.1111/jan.15220Links to an external site.
Shah, R. M., Zhang, Q., Chatterjee, S., Cheema, F., Loor, G., Lemaire, S. A., Wall, M. J., Jr, Coselli, J. S., Rosengart, T. K., & Ghanta, R. K. (2019). Incidence, Cost, and Risk Factors for Readmission After Coronary Artery Bypass Grafting. The Annals of thoracic surgery, 107(6), 1782–1789. https://doi.org/10.1016/j.athoracsur.2018.10.077
Wingate, K. S., Woods, S., Whitaker-Brown, C., & Kelly, W. S. (2019). Preventing Rehospitalization by Bringing Primary Care to the Bedside. The Journal for Nurse Practitioners, 15(5), e93–e95. https://doi.org/10.1016/j.nurpra.2018.12.022