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Published on: June 10, 2025
Nursing-Sensitive Process Indicators Predicting 30-Day Readmission in Chronic Heart Failure
Mohammad Sahebkar1, Mohammad Reza Ghasemi2
1School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Nursing interventions like fall prevention and medication education significantly impact 30-day readmission rates for chronic heart failure patients. Improving discharge preparation can reduce preventable hospital returns.
Area of Science:
- Nursing Science
- Cardiology
- Public Health
Background:
- Unplanned 30-day readmissions for chronic heart failure (CHF) pose challenges to healthcare quality and patient safety.
- Identifying predictive nursing-sensitive indicators is crucial for improving patient outcomes.
Purpose of the Study:
- To identify nursing-sensitive process indicators during hospitalization and at discharge that predict 30-day hospital readmission in adults with CHF.
- To inform targeted nursing interventions aimed at reducing readmission rates.
Main Methods:
- Retrospective case-control study involving 640 adult CHF patients.
- Data collected on nursing-sensitive indicators: in-hospital falls, fall-risk identification, discharge education, post-discharge follow-up, medication knowledge, polypharmacy, and dosing frequency.
- Comparison between readmitted cases (n=320) and non-readmitted controls (n=320).
Main Results:
- In-hospital falls, fall-risk identification, poor medication knowledge, polypharmacy, and complex medication schedules were associated with increased 30-day readmission odds.
- Structured nursing education at discharge significantly reduced the likelihood of 30-day readmission.
Conclusions:
- Nursing-sensitive process indicators independently predict 30-day readmission in adults with CHF.
- Strengthening fall prevention, enhancing medication education, and improving discharge preparation are actionable nursing interventions.
- Targeted nursing interventions can improve discharge readiness and reduce preventable readmissions.
Aim(S):
To identify nursing-sensitive process indicators documented during hospitalization and at discharge that predict 30-day hospital readmission among adults with chronic heart failure (CHF).
Design:
A retrospective case-control study.
Methods:
This study included 640 adults hospitalized with CHF at two cardiac referral centres in Sabzevar, Iran, between February 2020 and April 2024. Cases were patients readmitted within 30 days of discharge (n = 320), and controls were patients without readmission during this period (n = 320). Data were extracted from medical records on nursing-sensitive process indicators, including in-hospital falls, fall-risk identification at admission, structured nursing education at discharge, nursing-led post-discharge follow-up, patient knowledge of prescribed medications, polypharmacy (≥ 4 medications at discharge), and medication dosing frequency. Sociodemographic and clinical characteristics were also collected.
Results:
In-hospital falls, identification of fall risk at admission, poor knowledge of prescribed medications, polypharmacy, and complex medication dosing schedules were associated with higher odds of 30-day readmission. In contrast, receipt of structured nursing education at discharge was associated with a significantly lower likelihood of 30-day readmission.
Conclusion:
Nursing-sensitive process indicators are significant and independent predictors of 30-day hospital readmission among adults with CHF. Strengthening fall prevention strategies, improving medication-related education, and enhancing discharge preparation represent actionable nursing interventions to reduce avoidable 30-day readmission.
Implications For The Profession And/Or Patient Care:
Targeted nursing interventions focused on fall prevention, medication management, and structured discharge education may improve discharge readiness, enhance continuity of care, and reduce preventable 30-day readmission in patients with CHF.
Problem Addressed:
Unplanned 30-day readmission following hospitalization for chronic heart failure remains a persistent challenge for healthcare quality and patient safety.
Main Findings:
Several nursing-sensitive process indicators, particularly fall-related indicators and discharge education, independently predicted readmission risk.
Research Impact:
The findings support the integration of targeted nursing-led interventions in cardiac and medical units to reduce readmission risk.
Reporting Method:
This study was reported in accordance with the STROBE guidelines for observational studies.
Patient Or Public Contribution:
No patient or public involvement was included in the design, conduct, or reporting of this study.
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