Patient education and follow-up units in Iran: A quality improvement project
Abstract
Background & Aim: The rising prevalence of chronic and non-communicable diseases, presents significant challenges to health systems. This study aims to empower patients and their families by establishing patient education and follow-up units, thereby improving readmission rates, reducing unplanned referrals to emergency departments, and enhancing patient satisfaction, which are key nursing-sensitive indicators.
Methods & Materials: This perspective article presents a quality improvement project utilizing the Plan-Do-Study-Act cycle model. Initially, the problem of non-compliance among discharged patients and the resulting adverse consequences were identified. Consequently, a program for patient and family education and follow-up post-discharge was proposed. In the second step, patient education and follow-up units were implemented across three universities of medical sciences, and the results were analyzed in the third step. Upon confirming the achievement of the expected outcomes, the fourth step involved the national dissemination of implementation guidelines.
Results: The established units in hospitals demonstrated significant improvements in NSIs. The percentage of readmission among follow-up patients decreased from 14.3% in the first half of 2023 to 6.6% in the first half of 2024. The indicator of unplanned referrals dropped from 8.93% to 6.1% over the same period. Additionally, patient satisfaction increased from 91% to 93%.
Conclusion: The experience of establishing patient education and follow-up units highlights that this strategy during the transition to home is an effective, affordable, and sustainable solution that can improve NSIs. This approach, facilitated by nurses, can play a crucial role in managing non-communicable and chronic diseases.
2. Rim J-Y, Tassot C. Towards universal social protection: Lessons from the universal health coverage initiative. Development Policy Papers, No 20, OECD Publishing, Paris, . 2019(20).
3. Borg S, Henderson A, Taurima K, Johnston AN. Emergency nursing nurse sensitive indicators: An integrative review. International Emergency Nursing. 2023;66:101234.
4. Oner B, Zengul FD, Oner N, Ivankova NV, Karadag A, Patrician PA. Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open. 2021;8(3):1005-22.
5. Khosravi A, Ravari A, Mirzaei T, Gholamrezapour M. Effects of a comprehensive care program on the readmission rate and adherence to treatment in elderly patients with chronic obstructive pulmonary disease. Tanaffos. 2020;19(4):401.
6. Panattoni L, Fedorenko C, Greenwood-Hickman MA, Kreizenbeck K, Walker JR, Martins R, et al. Characterizing potentially preventable cancer-and chronic disease-related emergency department use in the year after treatment initiation: a regional study. Journal of Oncology Practice. 2018;14(3):e176-e85.
7. Cooper E, Hutchinson A, Sheikh Z, Taylor P, Townend W, Johnson MJ. Palliative care in the emergency department: A systematic literature qualitative review and thematic synthesis. Palliative Medicine. 2018;32(9):1443-54.
8. Mariotto AB, Robin Yabroff K, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. Journal of the National Cancer Institute. 2011;103(2):117-28.
9. Tabriz AA, Trogdon JG, Fried BJ. Association between adopting emergency department crowding interventions and emergency departments' core performance measures. The American Journal of Emergency Medicine. 2020;38(2):258-65.
10. Hertzberg VS, Wang YA, Elon LK, Lowery-North DW. The risk of cross infection in the emergency department: a simulation study. Infection Control & Hospital Epidemiology. 2018;39(6):688-93.
11. Motealehi A, Vafaeenasab M, Bahariniya S, Raadabadi M, Safari M. Patients' Satisfaction with Inpatient Services in Selected Wards of Some Hospitals Affiliated to Yazd Shahid Sadoughi University of Medical Sciences in 2016. The Journal of Tolooebehdasht. 2020; 19(4): 37-51.
12. Taghavi Larijani T, Najafi F. Patient satisfaction survey of nursing care and services in Iran: a systematic review. Education and Ethics In Nursing. 2019;8(1-2):54-65.
13. Pouresmail Z, Heshmati Nabavi F, Rassouli M. Quality of services in health education nurse-led clinics: An Iranian service providers and service recipients experience. BMC Health Services Research. 2024;24(1):581.
14. Knudsen SV, Laursen HVB, Johnsen SP, Bartels PD, Ehlers LH, Mainz J. Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Services Research. 2019;19(1):683.
15. Hosseinnejad A, Rassouli M, Jahani S, Elahi N, Molavynejad S. Community Health Nursing in Iran: A Review of Challenges and Solutions (An Integrative Review). Frontiers in Public Health. 2022;10.
16. Hosseinnejad A, Rassouli M, Jahani S, Elahi N, Molavynejad S. Scope of Iranian community health nurses ‘services from the viewpoint of the managers and nurses: A content analysis study. BMC Nursing. 2022;21(1):145.
17. Iranian Deputy Minister of Nursing. Identification of unmet health care needs of Iranian community members and nursing services that can be provided at the community level, 2023. Available at: https://dn.behdasht.gov.ir
18. De Regge M, De Pourcq K, Meijboom B, Trybou J, Mortier E, Eeckloo K. The role of hospitals in bridging the care continuum: A systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Services Research. 2017 Dec;17:1-24.
19. Woods CE, Jones R, O’Shea E, Grist E, Wiggers J, Usher K. Nurse‐led postdischarge telephone follow‐up calls: A mixed study systematic review. Journal of Clinical Nursing. 2019 Oct;28(19-20):3386-99.
20. Bani Ardalan H, Motalebi SA, Shahrokhi A, Mohammadi F. Effect of education and telephone follow-up on care burden of caregivers of older patients with stroke. Iranian Journal of Ageing. 2022;17(2):290-303.
21. Farley H. Promoting self‐efficacy in patients with chronic disease beyond traditional education: A literature review. Nursing Open. 2020;7(1):30-41.
22. Javadi M, Behzadnezhad MM, Alizade M, Sharbafchizade N, Yaghoubi M. Challenges of Post-Discharge Follow-up in Psychiatric Patients in Isfahan Farabi Hospital: A Qualitative Study. Journal of Mazandaran University of Medical Sciences. 2022;32(210):100-7.
23. Nikkhah T, Bagheri H, Khajeh M, Khosravi A. The effect of post-discharge telephone follow-up on the inherent dignity of patients with heart failure. Avicenna Journal of Nursing and Midwifery Care. 2021;29(2):91-101.
24. Koohestani HR, Baghcheghi N. The Relationship Between the Use of Medicinal Plants and Medication Adherence in the Elderly with Chronic Diseases. Iranian Journal of Ageing. 2022;17(2):276-89.
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Issue | Vol 12 No 1 (2025): Winter | |
Section | Perspective Piece(s) | |
DOI | https://doi.org/10.18502/npt.v12i1.17521 | |
Keywords | ||
patient education; follow up; nursing-sensitive indicators (NSIs); quality improvement; PDSA model |
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