Document Type

Article

Language

eng

Publication Date

7-2018

Publisher

Wolters Kluwer Health, Inc.

Source Publication

Nursing Research

Source ISSN

0029-6562

Abstract

Background: Statistical models for predicting readmissions have been published for high-risk patient populations but typically
focus on patient characteristics; nurse judgment is rarely considered in a formalized way to supplement prediction models.
Objectives: The purpose of this study was to determine psychometric properties of long and short forms of the Registered Nurse
Readiness for Hospital Discharge Scale (RN-RHDS), including reliability, factor structure, and predictive validity.
Methods: Data were aggregated from two studies conducted at four hospitals in the Midwestern United States. The RN-RHDS was
completed within 4 hours before hospital discharge by the discharging nurse. Data on readmissions and emergency department
visits within 30 days were extracted from electronic medical records.
Results: The RN-RHDS, both long and short forms, demonstrate acceptable reliability (Cronbach’s alphas of .90 and .73,
respectively). Confirmatory factor analysis demonstrated less than adequate fit with the same four-factor structure observed in
the patient version. Exploratory factor analysis identified three factors, explaining 60.2% of the variance. When nurses rate
patients as less ready to go home (<7 out of 10), patients are 6.4–9.3 times more likely to return to the hospital within 30 days,
in adjusted models.
Discussion: The RN-RHDS, long and short forms, can be used to identify medical-surgical patients at risk for potential unplanned
return to hospital within 30 days, allowing nurses to use their clinical judgment to implement interventions prior to discharge.
Use of the RN-RHDS could enhance current readmission risk prediction models.

Background: Statistical models for predicting readmissions have been published for high-risk patient populations but typically focus on patient characteristics; nurse judgment is rarely considered in a formalized way to supplement prediction models.

Objectives: The purpose of this study was to determine psychometric properties of long and short forms of the Registered Nurse Readiness for Hospital Discharge Scale (RN-RHDS), including reliability, factor structure, and predictive validity.

Methods: Data were aggregated from two studies conducted at four hospitals in the Midwestern United States. The RN-RHDS was completed within 4 hours before hospital discharge by the discharging nurse. Data on readmissions and emergency department visits within 30 days were extracted from electronic medical records.

Results: The RN-RHDS, both long and short forms, demonstrate acceptable reliability (Cronbach's alphas of .90 and .73, respectively). Confirmatory factor analysis demonstrated less than adequate fit with the same four-factor structure observed in the patient version. Exploratory factor analysis identified three factors, explaining 60.2% of the variance. When nurses rate patients as less ready to go home (<7 out of 10), patients are 6.4-9.3 times more likely to return to the hospital within 30 days, in adjusted models.

Discussion: The RN-RHDS, long and short forms, can be used to identify medical-surgical patients at risk for potential unplanned return to hospital within 30 days, allowing nurses to use their clinical judgment to implement interventions prior to discharge. Use of the RN-RHDS could enhance current readmission risk prediction models.

Comments

Accepted version. Nursing Research, Vol. 67, No. 4 (July.August 2018): 305-313. DOI. © 2018 Wolters Kluwer Health, Inc. Used with permission.

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