is admitted to the hospital with HF, and the insurance will pay $10,000 for
his care. It costs the hospital $10,000 to provide 6 days of care for this type of
patient. If the patient stays for 6 days, the hospital breaks even. If the patient
goes home in fewer than 6 days, the hospital profits because it still receives
$10,000. If the patient stays longer than 6 days, the extra costs of providing care
such as salaries, food, and supplies are assumed by the hospital.
Some nurses decide to approach administration and change the care pro-
cess whereby HF patients are discharged in 4 days. Is this a good idea? Will
patients be ready to go home in 4 days? HF patients often need several days
for medications to work. They also need education related to diet and activity.
Some patients are so weak that they need the services of physical therapy. The
proposed decrease in LOS for HF patients means that the physical therapist
would need to see patients within 24 hours of admission. Will HF patients
be too sick during that time to benefit from a physical therapy evaluation?
Patients who are discharged before they are ready are at risk for being read-
mitted just days after discharge, potentially adding cost and compromising
quality of care. Readmissions can result in patient and family dissatisfaction
and mistrust of healthcare providers and the healthcare system. This example
illustrates how one simple change, discharging HF patients 2 days early, has
the potential to increase cost while expected benefits are not realized. To
achieve the most positive benefits, it is important to examine all aspects of
any proposed change.Apply What You Have Learned
Now that the policy has been written and has received the necessary administrative approvals,
the EBP committee must devise an implementation plan. Use strategies identified in this
chapter to create your plan, being sure to consider communication channels, equipment needs,
and any education that the staff might need. Include what outcomes you measure to know if the
intervention increases hand hygiene compliance.444 CHAPTER 16 Transitioning Evidence to Practice