PICOT Question and Literature Search Number of sources:
The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-reviewed research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
Use the “Literature Evaluation Table” to complete this assignment.
Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
The PICOT question will provide a framework for your capstone project.
Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.
Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
ANSWER
Reducing Readmission of Adults Patients after Knee Replacement Surgery
Student ID:
Institutional Affiliation
Date
Summary of Clinical Issue
In clinical practice, reducing readmission of adult patients following knee replacement surgery is of interest because of an increasing readmission rates for the patients group after a surgical operation. Despites evidence suggesting much has been done to reduce surgical sites infections in clinical practice, for instance by improving infection prevention and control practice, the causes of re-admissions 30 days after knee replacement surgery is not well understood. It many instances, postoperative readmissions poses risks to patients for developing complications, as well as other hospital acquired infections. This results in longer hospital stays consequently increasing cost of care and poor quality of care. It is therefore imperative that an evidence-based intervention is developed to prevent the adverse happenings in the patient group.
Hospital re-admission following a knee replacement surgery affects affect adult patients between the ages of 45 to 80. In every 10 surgical operations, 3 re-admissions were likely to be reported during my clinical practice. Postoperative infection causes poor wound healing, elongate hospital stays, requires additional interventions such as treatment with antibiotics, increases healthcare costs, and leads to reduction of reimbursements. Moreover, infections after surgery causes surgical complications for instance organ failure, sepsis, and death. Therefore, the problem is of concern to the entire hospital. Also, the problem is significant to nursing practice in that postoperative readmissions rates is a measure of quality, hence more readmission is a threat to quality of care provided, which may affect reimbursement of the hospital and the care staff. Conversely, reducing the postoperative readmission brings a lot of benefits such as reduced care cost, improved quality, high success rates of surgery, better wound healing, and elimination of complications.
PICOT question
The patient/population/problem, intervention, Comparison with other interventions and outcome (PICO) that include metrics for evaluation results for our group is based on the problem with a surgical patient with reducing readmitted to hospital with thirty-day are not learning how to manage their diagnosis affecting reimbursement of the hospital.
The purpose of the project is to determine if there is a correlation between increased education and awareness related to surgical site infections, and post-operative readmissions rates, including evaluation of how finding from different studies can be applied to practice to reduce rates of readmissions. Surgical site infection is the most common complication after an operation. Adult population between 45 to 75 years are at higher risks of infection with a hospital-acquired disease. The PICOT question is: In adult patients between the age of 40 to 75 years old, diagnosed with joint replacement (P), how effective is reducing surgical site infection through education and awareness (I), compared to when educatioin and awareness on surgical site infection is not conducted (C), reduces readmissions (O) after knee replacement surgery (T).
Literature Search
A search on literature were comprehensive conducted to identify relevant studies on the topic. Databases used included; PubMed ®, MEDLINE, CINAHL and Trip database. Search strategy included the elements of the PICOT question developed and MeSH terms derived (i.e. arthroplasty, postoperative SSIs and postoperative interventions, hospital readmissions, education and awareness after knee replacement. A total of 6 records were selected after through screening as shown in evaluation table below:
Literature Evaluation Table
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink |
Edwards et al. (2015). |
Lasater & Mchugh (2016).
https://doi.org/10.1093/intqhc/mzw007
|
Andriotti et al.(2019).
https://doi.org/10.1016/j.jss.2019.02.032
|
| How Does the Article Relate to the PICOT Question? | Edwards, Mears & Barnes (2017) relates to the study as it focuses on avoiding readmission post-discharge by determining the patient management support systems utilization in clinical practice. | The articles examines effects of nurse staffing on readmissions after hip and knee replacement | The article examines the association between optimal length of stays and readmission risk postoperative. |
| Quantitative, Qualitative (How do you know?) | Quantitative study.
It quantify the length of stay and reduction in readmissions when the support system introduced into the clinical pathway. |
Quantitative.
It calculate adjusted odds ratio (OR). |
Quantitative.
It quantified the readmission rates and length of stays. |
| Purpose Statement | To determine if utilization of a patient management support system (TAVHealth™) in clinical pathway would reduce our readmission rates during the episode-of-care. | To examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for US Medicare patients following elective total hip and knee replacement. | To assess the optimal length of stays associated with the lower postoperative readmission rate |
| Research Question | Is there a reduction in readmission rates when patient management support system (TAVHealth™) utilized at the point-of-care? | Is the nursing care associated with hospital readmissions after hip or knee replacement surgery? | Is there an association between optimal length of stay and readmission risk following common surgery? |
| Outcome | Is the length of stays reduced when patient support system utilized in clinical pathways? | Adjusted odds ratio (OR) of experiencing an unplanned readmission. | Invasive procedures have detrimental rate of discharge which would increase the potential for readmission as would any extended hospital LOS. |
| Setting
(Where did the study take place?) |
Hospital point-of-care | Acute care hospitals | Tricare |
| Sample | 1874 total joint arthroplasties | 112 017 Medicare patients admitted to an acute care hospital for an elective total hip or knee replacement. | Adult patients receiving common surgical procedures |
| Method | Retrospectively study | Cross-sectional analysis of secondary data. | Retrospective study |
| Key Findings of the Study | Low length of stays (1.2 days).
A significant reduction in readmissions (from 16.0% to 9.2%). |
Almost 6% of the patients were readmitted and 8% higher odds of 3 within 30 days. | Varied readmission rates.
Lower readmission risk on postoperative day-1 and increasing thereafter.. |
| Recommendations of the Researcher | Support systems are required after discharge to continue rapid recovery of patients. | Nursing care is linked to readmission outcomes after replacement surgery | Discharging patients a soon as it is feasible after hip and knee arthroplasty. |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | Kang et al. (2020).
https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.15057
|
Causey-Upton et al. (2020).
https://journals.lww.com/orthopaedicnursing/Abstract/2020/01000/Preoperative_Education_for_Total_Knee_Replacement_.6.aspx
|
Goldsmith et al. (2017).
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1474-8
|
| How Does the Article Relate to the PICOT Question? | The articles focus on understanding experiences and satisfaction of patients after hospital discharge education. Can help inform the design of patient-centred discharge education interventions. | Education was used as an interventions preoperatively involving | |
| Quantitative, Qualitative (How do you know?) | Qualitative study.
Qualitative telephone interviews were used. |
Qualitative study.
Online survey was utilized. |
Qualitative.
It examines patients’ experience and satisfaction post-Total knee athroplasty adults. |
| Purpose Statement | To explore adult general surgical patients’ perceptions of, and satisfaction with, discharge education provided by healthcare providers. | To describe the current design of preoperative education for TKR across the United States. | To understand the mportance of informational, clinical and personal support in patient experience with total knee replacement |
| Research Question | What perception do patients have following hospital discharge education? | What is the current design of preoperative education for TKR across the United States? | What are the importance of informational, clinical and personal support in patient experience with total knee replacement? |
| Outcome | Inadequate discharge education leads to patients’ inability to self-manage their recovery process. | Preoperative education aids in reducing the incidence of poor outcomes after total knee replacement (TKR) and increasing patient readiness for discharge home but is not well described in the literature. | TKA patients described their TKA experiences with concerned of support, or the provision of aid and assistance. |
| Setting
(Where did the study take place?) |
Hospital | The United States. | The British Columbia, Canada |
| Sample | 13 general surgical patients | Large group of national orthopaedic nurses | 45 TKA adult patients
|
| Method | A constructivist-interpretivist paradigm using qualitative interviews. | Online survey | In-depth interviews.
Cohort. |
| Key Findings of the Study | Themes identified;
Quality of discharge information influences patients’ post-discharge experience. The negative impact of contextual influences on delivery of discharge education. Patients actively participating in their surgical journey. Patients’ preferences with the delivery of discharge education. |
Common educational delivery method was verbal and written instruction.
A single session was used to deliver the education with a variety of topics. |
Support domains: (1) informational support, (2) clinical support, and (3) personal support. |
| Recommendations of the Researcher | Information sharing with patients fosters shared understanding towards goals and expectations. | Preoperative educational practices can improve patient outcomes following TKR surgery and support future research. | An expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience. |
Reference
Andriotti, T., Goralnick, E., Jarman, M., Chaudhary, M. A., Nguyen, L. L., Learn, P. A., Haider, A. H., & Schoenfeld, A. J. (2019). The Optimal Length of Stay Associated With the Lowest Readmission Risk Following Surgery. The Journal of surgical research, 239, 292–299. https://doi.org/10.1016/j.jss.2019.02.032
Causey-Upton, R., Howell, D. M., Kitzman, P. H., Custer, M. G., & Dressler, E. V. (2020). Preoperative education for total knee replacement: A national survey of orthopaedic nurses. Orthopaedic Nursing, 39(1), 23-34.
Edwards, P. K., Levine, M., Cullinan, K., Newbern, G., & Barnes, C. L. (2015). Avoiding readmissions—support systems required after discharge to continue rapid recovery?. The Journal of arthroplasty, 30(4), 527-530. https://doi.org/10.1016/j.arth.2014.12.029
Goldsmith, L. J., Suryaprakash, N., Randall, E., Shum, J., MacDonald, V., Sawatzky, R., Hejazi, S., Davis, J. C., McAllister, P., & Bryan, S. (2017). The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation. BMC Musculoskeletal Disorders, 18(1). https://doi.org/10.1186/s12891-017-1474-8
Kang, E., Gillespie, B. M., Tobiano, G., & Chaboyer, W. (2020). General surgical patients’ experience of hospital discharge education: A qualitative study. Journal of clinical nursing, 29(1-2), e1-e10.
Lasater, K. B., & Mchugh, M. D. (2016). Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement. International Journal for Quality in Health Care, 28(2), 253-258.
