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Updated: Nov 20, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
The Impact of Telephonic Follow-Up Within 2 Business Days Postdischarge on 30-Day Readmissions for Patients With
Victoria M Chestnut1, Karen Vadyak2, Matthew M McCambridge3
1Care Transitions and Navigations-Lehigh Valley Health Network, Allentown, PA Victoria_m.chestnut@lvhn.org.
Background:
Heart failure (HF) is a chronic condition associated with high rates of hospital readmissions. The prevalence and costs of HF are expected to rise dramatically by 2030 (Heidenreich,et al., 2013).
Objective:
A 24-month, retrospective study was conducted using electronic medical record (EMR) chart review, seeking to identify if postdischarge follow-up phone calls decreased 30-day readmissions in individuals with HF.
Methods:
The study included 705 adult participants who were admitted to the hospital for HF. Some received a postdischarge call within 2 business days of discharge, and some did not.
Results:
Participants who received the postdischarge call were less likely to be readmitted (20.1%) than participants who did not receive a postdischarge call (28.8%; p = .007). Participants who received the postdischarge call were more likely to have a follow-up visit within 14 days (70.1%) than participants who did not receive a postdischarge call (30.2%; p < .001).
Conclusions:
The findings from this study may help to drive future transitional care strategies for individuals diagnosed with HF.
Implications For Nursing:
Nurse-led transitional care interventions offer potential solutions to ensure safe, effective hospital discharges.
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