1. Fort Hays State University, Department of Nursing
Mending the “Other Heart” after Myocardial Infarction (MI) to Decrease Hospital Length of Stay
Introduction
Despite the clinical significance of the presence of depressive symptoms on adverse cardiac outcomes, screening for depressive symptoms is not a part of routine care for acute coronary syndrome (ACS) patients in the acute care setting. Potential reasons for this discrepancy are limited provider awareness and level of comfort with depressive symptom screening, provider time constraints, the stigma of depression, limitations in reimbursement for psychiatric patient services, and the lack of consensus on what screening method to use with the ACS population. (Frazier, 2014) There seems to be clear correlation between length of stay and depressive symptoms with patients with ACS.
Research Question
In adult acute inpatients post acute myocardial infarction (AMI), what is the effect of a standardized assessment of depressive symptoms on decreasing length of stay compared with no standardized assessment?
Purpose
To recognize depressive symptoms by utilizing a standardized screening tool in the ACS population in an effort to decrease the length of stay.
Christan Butler, RN
Fort Hays State University, Department of Nursing
Methods
The information presented was collected from a systematic review of 6 published research articles between the years These articles reviewed the benefits of utilizing a depression tool for ACS patients, however, it was I could not find articles within the last five years that was specific to decreasing the length of stay by utilizing these tools. It is apparent that more research needs to be done on this question.
Implications for Nursing
Keeping clear and comprehensive notes is crucial to ensure all nurses caring for patients with ACS know the patients’ clinical status, areas of concerns and management plan.
Recent hospital reductions in registered nurses (RNs) for hospital care raise concerns about patient outcomes, if care could become more efficient with standardized depressive screening tools like the PHQ2, the decreased length of stay would benefit nurses struggling to take adequate care of AMI patients.
Nurse led initiatives such as depressive screening, are shown to improve patient outcomes to include shorter average length of stay which will further empower participants to be nurse leaders and quality improvement champions.
Results
The AHA recommends using a two step screening process with use of the Patient Health Questionnaire 2 (PHQ 2). First, using the PHQ2, and if the screen is positive move onto the PHQ 9 consisting of 9 questions for a more thorough evaluation (Dobberstein, 2018)
The psycho-emotional effects of acute coronary syndromes may be substantial, and may radically change the way the patients relate to their own self and to the world. With an increased understanding of the relationship between such emotional response and the heightened risk of cardiovascular mortality, it is necessary to thoroughly assess the current overall treatment for cardiac patients. (Macovei, 2017)
In hospitalizations with a diagnosis of depression and/or anxiety, the odds of in-hospital mortality were reduced by 33% compared to those who were not diagnosed (Pino, 2018)
(Kumar, 2017)
References:
Conceptual Framework
The prevalence of depression in hospitalized (ACS) patients is 20% to 30%, which is three times greater than in the general population. Studies indicate that the presence of depressive symptoms is a major independent risk factor for future major adverse coronary events (MACE) in patients with ACS contributing to decreased quality of life and increased health care costs. (Frazier, 2014)
(Dalal, 2015)