Doctor of Nursing Practice (DNP) Projects
Access Control
Campus Access
Degree Program
Doctor of Nursing Practice
Degree Track
Public Health Nurse Leader
Year Degree Awarded
2015
DOI
https://doi.org/10.7275/7039956
Month Degree Awarded
May
Keywords
stroke, transitions of care, rehabilitation, readmissions
Advisor
Cynthia Jacelon
DNP Project Chair
Cynthia Jacelon
DNP Project Member Name
Joan Roche
DNP Project Outside Member Name
Sandra Bennett Illig
Abstract
Current post-acute care transitions are frequently fragmented, disorganized and can be confusing for patients and families. Through a coordinated and systematic approach to care transitions, readmissions to acute care may be reduced. Patients with stroke provide an excellent model for care transitions due to the complicated nature of the diagnoses, the prevalence of complications that occur and the potential to enter the healthcare system at any point along the continuum. Yet little evidence exists with respect to preventing stroke rehabilitation patients from being re-hospitalized to acute care.
The purpose of this capstone project was to implement and evaluate a checklist targeted to improve the transition of care in stroke patients discharged home from inpatient rehabilitation. The findings of the project suggest the checklist was effective in reducing readmissions for the stroke rehabilitation population discharged home. Further evaluation and validation is indicated by using the checklist with other rehabilitation diagnoses as well as within other rehabilitation units and facilities.
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