This document is a research proposal submitted for a nursing capstone course. It aims to reduce hospital readmissions by analyzing causes of readmissions and developing interventions. The literature review found that readmissions are increasing, resulting in hospital penalties. Effective interventions include providing discharge education and follow-up care after discharge. The proposal will develop a plan to implement these strategies and evaluate their effectiveness in reducing readmissions.

1. PUT YOUR HEADER HERE IN ALL CAPS
v
Reducing the cases of readmissions among patients
by
Mehrnoosh Ejlali
Evidence-based Practice Project
Submitted to the Faculty of NUR 49800 Capstone Course in
Nursing
College of Nursing
of Purdue University Northwest,
Hammond, Indiana
in partial fulfillment of course requirements for the degree of
Bachelor of Science
Month, 20xx
© copyright

2. Mehrnoosh Ejlali
20xx
all rights reserved
acknowledgments
Begin optional acknowledgments here.
table of contents
SectionPage
acknowledgments
iii
table of contents
iv
abstract
v
Sections
1. Introduction
1
2. Review of Literature and Synthesis of the Evidence
4
3. Plan for Implementation
xx
4. Plan for Evaluation
xx
5. Conclusions, Recommendations and Implications
xx
references
xx

3. appendices (If Applicable)
Appendix A – Put Title Here
xx
List of tables
TablePage
Table 1Summary of Reviewed
Evidence……………………………………………………...9
Table 2 Put Name of Table Here
xx
Table 3 Put Name of Table Here
xx
ABSTRACT
Begin writing abstract here. APA abstracts begin on margin and
do not indent. Please use headings in instructions
SECTION 1
Reducing the cases of readmissions among
patients.
One of the issues that are affecting the healthcare sector
is readmission. When a patient is readmitted, it means that there
is a high possibility that the healthcare practitioners failed to
intervene effectively. A person might be readmitted because he
or she did not fully recover from the previous illness. Also, a
person may be readmitted because healthcare practitioners
might have missed the cause of the illness. Therefore, it means
that they might have administered care that is not in line with
the issue of the patient.

4. Purpose
The purpose of the research topic is to ensure that the
problem at hand is addressed. The title of the research is trying
to look for ways in which the number of readmission cases can
be significantly reduced. In this case, it becomes evident that
the topic of research or the research is looking for an
intervention to a specific issue. The issue at hand is associated
with readmissions, and the intervention is to reduce the number
of readmission cases. The research also plays an essential role
in informing people or the audience about the issue of
readmission (Zuckerman, Sheingold, Orav, Ruhter, & Epstein,
2016). The healthcare sector has been suffering because of the
increasing numbers of readmissions. When the numbers of
readmissions continue to increase, it means that patients start to
lose faith and trust in the healthcare sector fraternity. When
research focuses on an issue, it does so because it wants people
to know more about the issue and to identify the best ways to
deal with the issue.
Relevance/significance
In the United States, there have been cases of
readmissions, and most of them are associated with
incompetent healthcare practitioners. The significance of the
research is seen in the goals that it helps to meet. The research
is relevant to the course in different ways. First, the research
has focused on an issue that is associated with the healthcare
sector. Therefore it means that the research findings will be
addressing the right audience. Second, the research has taken a
position that is essential in the field of healthcare. Healthcare
practitioners and professionals have a higher calling than only
offering care to patients (Figueroa, Joynt, Zhou, Orav, & Jha,
2017). They are also expected to look for solutions to the
problems that might be affecting patients. The significance of

5. the research can be tired of the direction and perspective it has
taken. The research is aimed at bringing a solution on the table,
and that means that it will be of benefit to the readers and
targeted audience (Zuckerman et al. 2016). Also, the research
has touched on an issue that is affecting patients not only in the
country but also in different parts of the world. The mentioning
of the problem creates awareness among healthcare practitioners
in different parts of the world.
Potential outcomes
ABC Health Care Centre is determined to analyze the
issues surrounding the cases of patient’s readmission and come
up with a long term solution to curb this issue. The study will
highlight on the essential strategies which should be embraced
in the health care facilities so as to reduce the cases of
readmission.
Clinical question
In hospitalized patients of all ages, how effective is
providing early discharge plan with proper discharge education
and follow up after discharge compare to patients who don’t get
right information and no discharge follow up on decreasing rate
of readmission in hospitals?
Section 2
Introduction
This section focuses on the review of literature related to this
research. It explores on a review of past studies done on
patient’s readmission issues. Emphasis is on the measures to
minimize the concept of readmission in the hospitals. The
review also depended on theoretical literature such as books,
research papers, magazines, health reports and information from
the Internet. However, the concentration was more on google
scholar articles and those from health reports. This was because
the latter explored more on the level or extent to which patients
have been readmitted in the hospitals. The remaining failed to
identify why the patients are readmitted as well as what can be

6. done to minimize this.
Therefore, different themes were described as per the previous
authors a well as their contradictions and consistencies. The
results from the above named were used to identify the existing
gaps in the studies; thus, making them an intent on the study.
Besides the section covers the findings of the study and later a
well-illustrated summary of the evidence was derived.Strategy
of appraisal was Melnyk’s observational-analytic designs level
of evidence. Level I had three sources, level II two source, level
IV one source, and level V one source.
Review of Literature and Synthesis of Evidence
The papers problem, intervention, as well as comparison and its
link to an outcome (PICO), involved the evaluation metrics
regarding groups on the issue of patient's readmission. This
primarily focused on a thirty-day experience in the management
of patients being readmitted in the hospitals. However, PICO
elements involved population; that is, in surgical patients facing
complications, how effective is reduced hospital penalties
compared to surgical initiatives, in reducing complications that
results to patient’s readmission?
Besides the intervening interest in this involved effectiveness of
reduced hospital penalties compared to surgical initiatives.
Despite this, the intervention's comparison failed to link
reduced hospital penalties to surgical initiatives. The latter
marked the outcome of decreasing rates complications that
results to patient’s readmission. Therefore, there was the intent
to minimize if not end the rate of patient readmission in the
hospitals; if possible, within a time limit of thirty days after the
first discharge.
However, to address the PICO questions, the literature review
was based on key terms; that is, patient discharge, rate of
readmission, care of transitions, and post-acute care.
Concerning the health care projects, the focus was on the
National Readmissions Database (NRD) as well as the google
scholar articles. Attention was based on this to bring different

7. and vital meaning when It comes to analyzing different
categories of readmission rates in patients. However, this
assumes an expected hospital stay pay.
Common Themes in the Literature Review
By analyzing the data in the National Readmissions Database, a
reveal of common topics was evident. These included arising of
penalty fees in hospitals, surgery performance, and surgical
initiative to avoid readmissions.
Arising of penalty fees in hospitals
Earlier, research in hospitals was intended to develop
techniques to make it easier to contemplate the impact of
finances on patient's readmissions on current ecosystems
(Goodwin et al., 2015). Several scholars agree in their studies
that programs for readmission lead to penalize in the hospitals.
This moves to a higher degree than even the excess expectations
speculated in the hospitals.
Surgery Performance Intervention with Hospital Penalties
Goodwin et al. (2015) say the primary issue noted has raised
many readmissions with the performance of a joint surgery
especially for the older population of adults from complications
resulting from mobile follow-ups lacking to be initiated by a
hospital health professional after discharging patients home.
Health centers experience a minimal payment from Medicare
because of government programs that initiate penalties where
there is more readmission of patients in thirty days in their final
hospital period. 18% of those under Medicare and are
discharged from health care facilities must be readmitted hence,
accounting for not less than fifteen billion spent according to
report from MPAC (Goodwin & Ford, 2018). Health centers
have not provided an estimate although different other officials
have done it locally. For instance, US hospitals recorded more
fines in 2013 compared to 2014 despite having not paid other
fees since then (Shams, Ajorlou, & Yang, 2015).

8. Surgical Initiative to Avoid Readmissions.
Readmission issues had been noticed from the adult populations
in the surgery process because of dislocations and falls.
Research indicated that most of the readmissions can be
prevented by follow-ups after initial hospital visitations.
Initiatives that can boost the quality of care comprised of
assessing for hospital rates of readmission (Tapper & Volk,
2017). The general unplanned sessions for readmission had
been four percent in thirty days as well as seven percent in
ninety days from a survey done after surgery of total hip
arthroplasty (Pham, Li & Williams, 2016). However,
prevention for readmission is achievable through a follow as
well as planning the discharge effectively after the initial
hospital visit. The is a need for exploring better ways to boost
the little efforts put in reducing readmission.
Consistencies and Contradictions in The Literature.
Shaheen et al. (2019) argued that patient's readmissions in the
hospitals have been a concern that is alarming as far as health
care is involved. There has been a lack of compatibility in
secondary patient's diagnosis and how eligible they should
emerge. This makes the consistency of measuring their features
to fail thus, reducing the ability to minimize the risk of
mortality rate for readmitted patients. Besides, minimal
preventable readmissions are associated with more significant
complications (Arora et al., 2017). This has been confusing
since no essential differences are found or rates of preventable
admissions.
Existing Gaps in The Literature Review
Few research studies had focused on the significance of
reducing the readmission of patients thus, major contradicting
factors emerge. Hence, there were no consistent measures that
had been discovered or approved on minimizing the rate of
readmissions with improved performance in finance. This is

9. because various scholars have explored the level or extent to
which patients have been readmitted in hospitals. Despite they
fail to identify why the patients are readmitted as well as what
can be done to minimize this (Tapper et al., 2016). There was
also a lack of national information represented in hospital rates
of readmissions for different age brackets. NRD comprised data
that approximated eighteen million patient's discharge that
occurred in a single year.
Findings
Based on the reviewed literature, it is clear that an effective
measure to reduce readmissions of patients can be implemented
in the policies of health care. With this being made permanent,
the challenge can be stopped as most of the causes will have
been fought. Shams, Ajorlou, & Yang, (2015) argue that
professionals in health sector must be concerned about the
welfare of patients discharged through making follow-ups.
Perhaps the clinicians can be grouped to make a follow-up of a
different patient who is discharged initially
PICO Question: “In hospitalized patients of all ages, how
effective is providing early discharge plan with proper
discharge education and follow up after discharge compare to
patients who don’t get right information and no discharge
follow up on decreasing rate of readmission in hospitals?”
Key words: Patient's discharge, rate of readmission, care of
transitions, and post-acute care.
Databases Searched: Google scholar articles and National
Readmissions Database
Table 1
Summary of Reviewed Evidence
Author(s) and Date of Publication ONLY
Sample/Setting/
Design

10. Data Collection Tools
Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)
(Pham, Li, & Williams, 2016)
Design:
Clinician guideline
Setting:
Hospital settings
Sample:
N=2 systematic reviews
Scales for risk assessment used in the 4 systematic reviews
1. Patients need to have support all through unhealthy periods-
based ion the review
Strengths:
Clinician guidelines are a high-level evidence.
Weaknesses:
The information from review might be inaccurate.
Conclusions:

11. Recommended guideline for further studies in patient’s
readmissions
Level II (risk assessment scales)
Author(s) and Date of Publication ONLY
Sample/Setting/
Design
Data Collection Tools
Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)
(Shams, Ajorlou, & Yang, 2015)
Design:
Literature review
Setting:
Readmission checklists in various hospitals
Sample:
N= 20 studies
Single interventions in questionnaires
1.Male patients are less readmitted compared to women
Strengths:
Study interventions appraised of quality through use of
questionnaires

12. Weaknesses:
The information in questionnaire might be inaccurate
Conclusions:
Some single intervention studies could not demonstrate impacts.
Level I
(Goodwin & Ford, 2018)
Design:
Literature review
Setting:
Long-run and acute care
Sample:
N= 17 studies
Case studies analyzation
1.The rate of patient surgery has increased.
2.15 reports prove on surgery improvements
Strengths:
Analyzed studies were quality based on Clinicians reports.
Weaknesses:
Some information omitted for confidentiality.
Conclusions:

13. Acute care prevention can minimize surgery rates
Level I
Author(s) and Date of Publication ONLY
Sample/Setting/
Design
Data Collection Tools
Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)
(Tapper & Volk, 2017)
Design:
Systematic review
Setting:
Worldwide hospitals
Sample:
N=30 studies in 7 different nations.
Experimental designs from electronic databases.
1.Children follow in readmission process.
2.Interventions were multiply used in major studies.
Strengths:
Quality assessed using criteria published in clinical guidelines

14. Weaknesses:
Confidence level was low studies as they were very simple.
Conclusions:
Studies reveal on no course of action planned.
Level II
(Pham, Li, & Williams, 2016)
Design:
Longitudinal research
Setting
inapplicable
Sample
inapplicable
Survey
1.Most of the readmissions are unplanned
Weakness:
A great population is ignored in the study
Level IV
Author(s) and Date of Publication ONLY
Sample/Setting/
Design
Data Collection Tools

15. Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)
(Tapper, & Volk, 2017)
Design:
Cohort
prospective
study
Setting:
19 units
Case study
1.Financial support in hospitals result to clinicians being less
careful in surgery
Strengths:
The study had a powered sample size with 486 patients (N=150
in similar studies).
Weaknesses:
No randomization as well as control groups.
Conclusions:
Interventions involved a bundle of care exercised by nursing
staff.

16. Level V
(Goodwin et al., 2015)
Design:
Cluster randomized controlled trial (RCT)
Setting:
secondary hospitals
Sample: N= 5 secondary hospitals
Data collected through assessment tools based on demographics.
1.Cesarean method might cause women readmission to hospitals
Strengths:
Strength of women undergoing the process. Thus, advanced
technology used.
Weaknesses:
Small number leads to irrelevance of information.
Conclusions:
Major significant effects after C-method left in most patients.
Level I
Author(s) and Date of Publication ONLY
Sample/Setting/
Design
Data Collection Tools

17. Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)
(Tapper & Volk, 2017)
Design:
Clinician guidelines
Setting:
Worldwide settings
Sample:
N= 30 hospitals
Survey, case series, and quasi experiments
1.The principles of psychology have not been analyzed by the
experts with regard to patients
Strengths:
Highest level of evidence from clinical report and guidelines
Recommendation strength provided.
Weaknesses:
Psychological information from case series might be pseudo.
Conclusions:
Interventions in the guidelines are recommended to be evidence
based

18. Level V
Section 3
Plan for Implementation
Begin writing here.
Table 2
Estimated Timetable Blueprint for Implementation
Task
Estimated Date
of Start
Estimated Date of Completion
Person Responsible

19. section 4
Plan for Evaluation
Begin writing here.
Table 3
EBP Evaluation Plan
Outcome(s)
Measures/Measurement
Time of Collection/Person Responsible

20. section 5
Conclusions, Recommendations and Implications
Begin writing here.
References
Arora, S., Patel, P., Lahewala, S., Patel, N., Patel, N. J.,
Thakore, K., ... & Shah, M. (2017). Etiologies, trends, and
predictors of 30-day readmission in patients with heart failure.
The American journal of cardiology, 119(5), 760-769.
Figueroa, J. F., Joynt, K. E., Zhou, X., Orav, E. J., & Jha, A. K.
(2017). Safety-net hospitals face more barriers yet use fewer
strategies to reduce readmissions. Medical care, 55(3), 229.
Goodwin, A. J., Rice, D. A., Simpson, K. N., & Ford, D. W.
(2015). Frequency, cost and risk factors of readmissions among
severe sepsis survivors. Critical care medicine, 43(4), 738.
Goodwin, A. J., & Ford, D. W. (2018). Readmissions among
sepsis survivors: Risk factors and prevention. Clinical
pulmonary medicine, 25(3), 79.

21. Pham, Q. H., Li, S. X., & Williams, B. C. (2016). Risk factors
and effects of care management on hospital readmissions among
high users at an Academic Medical Center. Care Management
Journals, 17(3), 134-139.
Shams, I., Ajorlou, S., & Yang, K. (2015). A predictive
analytics approach to reducing 30-day avoidable readmissions
among patients with heart failure, acute myocardial infarction,
pneumonia, or COPD. Health care management science, 18(1),
19-34.
Shaheen, A. A., Nguyen, H. H., Congly, S. E., Kaplan, G. G., &
Swain, M. G. (2019). Nationwide estimates and risk factors of
hospital readmission in patients with cirrhosis in the United
States. Liver International, 39(5), 878-884.
Tapper, E. B., Finkelstein, D., Mittleman, M. A., Piatkowski,
G., Chang, M., & Lai, M. (2016). A quality improvement
initiative reduces 30-day rate of readmission for patients with
cirrhosis. Clinical Gastroenterology and Hepatology, 14(5),
753-759.
Tapper, E. B., & Volk, M. (2017). Strategies to reduce 30-day
readmissions in patients with cirrhosis. Current
gastroenterology reports, 19(1), 1.
Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., &
Epstein, A. M. (2016). Readmissions, observation, and the
hospital readmissions reduction program. New England Journal
of Medicine, 374(16), 1543-1551.
APPENDICES
Begin here.

22. PAGE
PUT YOUR HEADER HERE IN ALL CAPS
v
Reducing the cases of readmissions among patients
by
xxxxxxxxx xxxxxx
Evidence-based Practice Project
Submitted to the Faculty of NUR 49800 Capstone Course in
Nursing
College of Nursing
of Purdue University Northwest,
Hammond, Indiana
in partial fulfillment of course requirements for the degree of
Bachelor of Science
Month, 20xx
© copyright

23. xxxxxxxxx xxxxxx
20xx
all rights reserved
acknowledgments
Begin optional acknowledgments here.
table of contents
SectionPage
acknowledgments
iii
table of contents
iv
abstract
v
Sections
1. Introduction
xx
2. Review of Literature and Synthesis of the Evidence
xx
3. Plan for Implementation
xx
4. Plan for Evaluation
xx
5. Conclusions, Recommendations and Implications
xx

24. references
xx
appendices (If Applicable)
Appendix A – Put Title Here
xx
List of tables
TablePage
Table 1 Put Name of Table Here
xx
Table 2 Put Name of Table Here
xx
Table 3 Put Name of Table Here
xx
ABSTRACT
Begin writing abstract here. APA abstracts begin on margin and
do not indent. Please use headings in instructions
SECTION 1
Reducing the cases of readmissions among
patients.
One of the issues that are affecting the healthcare sector
is readmission. When a patient is readmitted, it means that there
is a high possibility that the healthcare practitioners failed to
intervene effectively. A person might be readmitted because he
or she did not fully recover from the previous illness. Also, a
person may be readmitted because healthcare practitioners
might have missed the cause of the illness. Therefore, it means
that they might have administered care that is not in line with

25. the issue of the patient.
Purpose
The purpose of the research topic is to ensure that the
problem at hand is addressed. The title of the research is trying
to look for ways in which the number of readmission cases can
be significantly reduced. In this case, it becomes evident that
the topic of research or the research is looking for an
intervention to a specific issue. The issue at hand is associated
with readmissions, and the intervention is to reduce the number
of readmission cases. The research also plays an essential role
in informing people or the audience about the issue of
readmission (Zuckerman, Sheingold, Orav, Ruhter, & Epstein,
2016). The healthcare sector has been suffering because of the
increasing numbers of readmissions. When the numbers of
readmissions continue to increase, it means that patients start to
lose faith and trust in the healthcare sector fraternity. When
research focuses on an issue, it does so because it wants people
to know more about the issue and to identify the best ways to
deal with the issue.
Relevance/significance
In the United States, there have been cases of
readmissions, and most of them are associated with
incompetent healthcare practitioners. The significance of the
research is seen in the goals that it helps to meet. The research
is relevant to the course in different ways. First, the research
has focused on an issue that is associated with the healthcare
sector. Therefore it means that the research findings will be
addressing the right audience. Second, the research has taken a
position that is essential in the field of healthcare. Healthcare
practitioners and professionals have a higher calling than only
offering care to patients (Figueroa, Joynt, Zhou, Orav, & Jha,

26. 2017). They are also expected to look for solutions to the
problems that might be affecting patients. The significance of
the research can be tired of the direction and perspective it has
taken. The research is aimed at bringing a solution on the table,
and that means that it will be of benefit to the readers and
targeted audience (Zuckerman et al. 2016). Also, the research
has touched on an issue that is affecting patients not only in the
country but also in different parts of the world. The mentioning
of the problem creates awareness among healthcare practitioners
in different parts of the world.
Potential outcomes
The EBP project looks forward to providing a solution to
the problem at hand. The issue at hand is readmission, and the
project is looking for ways to reduce the number of people who
are readmitted. The outcomes of the project will be to outline
the strategies and methods that healthcare practitioners should
utilize to reduce the causes of readmissions in hospitals.
Clinical question
How effective is providing early discharge plan with
proper discharge education and follow up after discharge among
hospitalized patients of all ages compare to patients who don’t
get right information and no discharge follow up on decreasing
rate of readmission in hospitals?
Section 2
Review of Literature and Synthesis of Evidence
Begin writing here.
PICO Question:
Keywords:

27. Databases Searched:
Table 1
Summary of Reviewed Evidence
Author(s) and Date of Publication ONLY
Sample/Setting/
Design
Data Collection Tools
Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)

29. Section 3
Plan for Implementation
Begin writing here.
Table 2
Estimated Timetable Blueprint for Implementation
Task
Estimated Date
of Start
Estimated Date of Completion
Person Responsible

30. section 4
Plan for Evaluation
Begin writing here.
Table 3
EBP Evaluation Plan
Outcome(s)
Measures/Measurement

31. Time of Collection/Person Responsible
section 5
Conclusions, Recommendations and Implications
Begin writing here.
References
Figueroa, J. F., Joynt, K. E., Zhou, X., Orav, E. J., & Jha, A. K.
(2017). Safety-net hospitals face more barriers yet use fewer
strategies to reduce readmissions. Medical care, 55(3), 229.
Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., &
Epstein, A. M. (2016). Readmissions, observation, and the
hospital readmissions reduction program. New England Journal
of Medicine, 374(16), 1543-1551.
APPENDICES
Begin here.

32. PAGE