Reduction of Hospitalization and Re-hospitalization by Managed Care Organization


Reduction of Hospitalization and Re-hospitalization by ManagedCare Organization

Table of Contents

Abstract 2

Introduction 3

Foundational Work 4

Problem Statement 4

Stakeholders 5

Project conceptualization 6

A conceptual Framework for the Managed Healthcare 6

Outcomes 7

Solution 8

Project Implementation 9

Nurses Role and Responsibility 9

Project Leadership Role and Responsibility 10

Employed Strategies 11

Outcomes and Significance 13

Achievement of Outcomes 13

Criteria 13

Influencing Factors 14

Reflection on the Knowledge 15

Significance of Organization and Stakeholders 15

Organization 15

Stakeholders 16

Conclusion 16

References 18


Hospitalization and re-hospitalizations due to sepsis are a criticalissue that requires thorough study and research. The following studydemonstrates the probability and possibility of the care managementprograms to address the critical problem. The project seeks todiscover how care coordination and transition among high-riskpatients can be improved to ensure that cases of sepsis readmissionare reduced from healthcare facilities. Through the reduction ofsepsis cases, this project aims to discover ways of minimizing orpreventing unnecessary cost and methods of reduction of mortalityrates.

The initial part of the project has concentrated on the foundationalwork which has aimed at determining the key stakeholders bothaffected directly and indirectly. The project was pinned down usingtheoretical perspectives. The outcomes of the project have beendiscussed as well as how the problem solves the problem. The secondstage involved the project implementation phase. In this period, therole and responsibility of nurses have been clearly elaborated. Therole and the responsibilities of the nurses have as well beenanalyzed. The strategies that have been implemented in the projecthave also been explained in this segment.

The third stage of the analysis of the outcomes and theirsignificances. The criteria used for the discussion of the findingswill be discussed. The influencing factors that affected the resultswill be as well analyzed. The importance of the project is afterwarddiscussed. The final part of the project has involved the conclusionpart. This report has had which has strengthened the empiricalfoundation for designing and providing managed care that as a resultis likely to reduce hospitalization and rehospitalization.


Avoidable hospitalization and rehospitalizations have been viewed aspointers disintegration within the health care system. The decay isaccompanied by minimal patient outcomes and presence of cost of carethat could be avoidable from the start. Rehospitalization is aregular, costly, and to some extent life-threatening event (McCarthyet al., 2015). Sepsis has often been associated hospitalization andrehospitalization within the healthcare sector. Sepsis has been oneof the oldest elusive syndromes within the field of health. Thepathogens related to sepsis have not been adequately explained asmost patients still die despite the successful eradication of thepathogens associated with the syndrome. Researchers have to demystifythe problem with the discovery of many theories behind the crisis(Rivero, 2015). Hospitals admission and readmission have always beencommon amongst patients. The cases have at times proved to be verycostly yet this a condition that can easily be prevented. There arespecific factors that are often related to the hospital admissionsand readmissions due to sepsis.

Improving the quality of the services offered by healthcarefacilities is an essential step in reducing readmissions. A highnumber of health centers work hard to ensure that the patients canreceive the best treatment from their premises. Therefore, better wayof care delivery has been discovered within the contemporary world.The environments within hospitals majorly contribute to thereadmissions within the facilities (McGaghie et al., 2011). Researchhas found that even though Gram-positive bacterial pathogens remainas the most shared basis of sepsis, fungal organisms are increasingquickly. Progress has been made over the years on the ways sepsis istreated, but the methods are still not satisfactory as they shouldbe. Death has been associated with the increased incidences ofsepsis. Owing to the increased rates of sepsis worldwide, clinicianshave dedicated their efforts and energy on how to reduce theseoccurrences (Rivero, 2015). The clinicians are concentrating on thevarious methods that the strategies being used in hospitals can beimproved to reduce readmission into the facilities.

Foundational WorkProblem Statement

Studies have shown continued, and increased incidences ofhospitalization and rehospitalization within healthcare facilitiesare due to the sepsis syndrome. Sepsis syndrome has even resulted innumerous deaths over the years. Research indicate that the study ofways to eliminate sepsis had begun from long ago. However, asresearch progress and new methods of managing sepsis is discovered,the incidences of patients contracting sepsis also increase over theyears (Martin, 2012).

Studies have analyzed the hospitalization of patients with sepsis andthe care within the facilities in which they are admitted. Despitethe growth of knowledge in the ways of improving the managed care,sepsis cases still continue to grow amongst patience.Rehospitalization rates of sepsis continue to increase in rates(McCarthy et al., 2015). The readmission was majorly due to therespiratory failures, pneumonia, complications due to the hospitaldevices, implants, and infections of the urinary tract and renal andintestines, kidney failure, amongst an endless list of the causes.

Studies have discovered that deaths due to sepsis are caused bydysfunctional organs but not the bacteria itself. Therefore, thisresearch will utilize the above-discussed results to ensure that waysfor hospitalization and rehospitalization due to sepsis is reducedwith the use of managed care for the utilization of the caremanagement (McGaghie et al., 2011). Through this project, ways ofreducing or preventing cost and reduction of mortality will bediscovered.


Stakeholders will be grouped according to those who have beendirectly affected by the project and those that have been indirectlyaffected by the project. Consumers, patients, families of thepatients, caregivers, and patient advocacy organizations are thefirst and foremost direct stakeholders of the project. The researchshould be able to answer the need and the questions of the immediatestakeholders. This is because these are individuals who have beenaffected by the sepsis condition (Silow-Carroll et al., 2011). As aresult, their health has continuously deteriorated, money and timeresources have also been lost band invested while dealing with thecondition. Acute cases even lead to the deaths of the patients.Family members suffer from loss of loved once, time and moneyresources. Some of these people are affected physically, social andpsychologically. Patients and families have suffered significant lossdue to sepsis as their core beliefs and value systems influence theirdecision when it comes to seeking health assistance (CMMS, 2015).Stereotyping has also resulted in patients refusing to seek medicalattention as they believe they will be okay.

Clinicians and their professional associations such as nurses andHealthcare institutions, such as hospital systems and medicalclinics, and their associations also are immediately affectedstakeholders from the sepsis infection. Clinicians being at the heartof decision-making, failure to make the decision that is likely tosave the health and lives of their patients may affect thepsychologically as well as their reputation and that of theirsanitary facilities. Due to the lack of good data on the conditionrelated to sepsis, clinicians and nurses have spent a lot of time andresources trying to come up with the most efficient solution.Additionally, healthcare institutions that make decisions regardingthe treatment and management have suffered from affected reputation.These institutions have not yet come up with correct, and the mostappropriate solutions to sepsis were hence resulting into loss oftrust amongst consumers.

Purchasers and payers, such as employers and public and privateinsurers have been affected in different ways. Their reputations andcredibility have been tarnished as people no longer trust on theirservices. Healthcare industry and trade associations have continuedto utilize resources while attempting to come up with the proper wayof preventing hospital admission and readmissions due to sepsis(McGaghie et al., 2011). A lot of finance have hence been spent onthe field. Health care policymakers at the Federal, State, and locallevels have all spent resources while attempting to come up with thebest evidence on what works well and what does not function wellabout sepsis. Comparative effectiveness research and patient-centeredoutcomes research have been used to help decision makers strategizepublic health programs, scheme health insurance coverage, andinitiate wellness and advocacy programs. The aim of all these hasbeen to provide people with the best possible information aboutdifferent medical treatment options (Olaisson, 2012). Health careresearchers and research institutions have gathered and analyzed theevidence from multiple sources on currently available treatmentoptions. These have resulted in the investment of different forms ofresources.

Project conceptualizationA conceptual Framework for the Managed Healthcare

Sepsis elimination


Quality services

Cost reduction




Patient treatment






Managed healthcare


Patient care

Patient needs

Activity theory has been used for the formation of the aboveconceptual framework. This approach has been used in the project forthe analysis of the interrelationship and connections that can beutilized for the achievement of the desired outcome. The project willconcentrate on the immediate stakeholders who are the patients, therules which include safety first before the achievement of intendedgoals. Tools and the process for the achievement of the desiredoutcome have also been listed in the framework (Roos, 2012).


Before the introduction of the advanced intensive care unit, severesepsis and septic shock cases occur as the vital organs within thebody could not be supported. However, even with the discovery of theintensive care unit, patients continue to die from sepsis syndromeand septic shock. The project will result in advanced training ofnurses, clinician and healthcare giver. This will result in betterand improved efficient method of handling cases of patients withsepsis. The project will result into better surveillance andmonitoring procedures being adopted. This will ensure that patientsare monitored at all time and hence no critical condition will gounnoticed (Silow-Carroll et al, 2011). The research is likely toresult in prompt initiation of therapy for the treatment ofunderlying infection as well as supporting the failing organs withinthe body. All the above precautions will lead in to decreased deathrates. As a well better treatment to increase recovery amongstsurvivors of the sepsis syndrome. The research will be able to comeup with the most efficient way of rehabilitating patients who recoverand heal from sepsis. The outcomes will also involve coming up withthe most efficient manner to determining the different health effectsthat sepsis survivor patients are likely to suffer from (Horstmeier,2012).

The management of spending will be improved to guarantee betterhealthcare into the future. The research is likely to come up withthe most efficient ways of saving finance while providing care topatients. This is because, without the research, the demand forhealth care services will increase while funding for the managementof the syndrome may fail to grow. So the money spent on health has tobe put to better use (Horstmeier, 2012). Therefore through thisresearch, the outcomes will not only save lives of individuals butalso save money being spent on the issue.


Through product innovation, the project introduced right and newservice that significantly improved the health of key stakeholders.There were important enhancements in technical specifications,components, and materials. Process innovation, on the other hand, ledto the implementation of a significantly improved treatment and caremethods. There were drug and patient safety monitoring at all levelsand places within the hospital. There were significant alterations ofthe techniques used for patient care. The doctors, nurses andpatients received more crucial information (Omachonu &amp Einspruch,2010). Organizational innovation solutions involved theimplementation of a new organizational method in the healthcarefacilities.

The resolved by the use of an electronic Clinician Health Recordsolution that empowers physicians and other healthcare providers tosteadily contact healthcare information collated from any number oftrusted sources relating to an individual patient in a structured andeasily accessible way. The program could have used an electronicPersonal Health Record solution that enables patients to record andselectively shares healthcare information about themselves and theirloved ones without fear of lack of privacy.

Project Implementation Nurses Role and Responsibility

The nurses will have an essential role in ensuring that the researchbecomes as successful as possible. The nurses will make sure thatthey administer while ate the same time carry out all the guidelinesand recommendations that will be provided to them by the research.The nurses have a significant role in ensuring the correct selectionwith a timely delivery of antibiotics to the respective units ifpatients. The nurses will make sure that they keep the diagnosticservices as efficient as they should. The diagnostic service includesthe laboratory, radiology as this are essential systems for thetreatment and diagnosis of sepsis (Martin, 2012).

The landscape of the care of sepsis patients is a collaborativeprocess. The process for the care of sepsis, therefore, requires amultidisciplinary team as well. This research being an essential steptowards the reduction of the admission and the readmission ofpatients who suffer from sepsis, nurses play a significant role inensuring that the project is successful (CMMS, 2015). The nursesshould be able to carry a timely recording of any fundamental changesto the appropriate assessment of the progress of any patient withinthe healthcare facility suffering from any form of diseases. Withsuch rapid evaluation and recordings of any heavy sigh in a patient,the nurses will play a significant role in early recognition ofsepsis. With the early discovery of sepsis in a patient, clinicians,and other medicine practitioners will be able to monitor effectivelythe progress and the development of the syndrome.

With the nurses’ role in the timely management of fluids andantibiotics and the attaining the essential lab work, the success ofany improvement project for sepsis is likely to be registered.Nurses’ role will be to provide regular reports to the physicians,with the periodic reports, the doctors’ position towards saving thelives as well as cost reduction will be made easier through accurateassessment of the patient’s conditions followed by the interventionof the sepsis patients as early as possible.

Project Leadership Role and Responsibility

The project leader is responsible for coming in conjunction with theproject sponsor to come up with the core objectives and aims of theproject. The Project manager will have to guarantee that the deliveryof the project is in agreement with the stipulated time limit,following the budget and of the required standard quality. The leaderof the project will warrant that resource of the project is aseffective as required.

For the Casper project, the project manager will have a significantrole in managing the leading project team and ensuring that theproject is undertaken as needed. The project leader is requi red tobecome a leader (Jones et al., 2015). The manager will be workingwith the team that will be in charge of undertaking the program andthe key stakeholders of the project. These individuals will includethe nurses, caregivers, family amongst many other stakeholders. Theproject leader will have to maintain his focus while providing aprecise bearing to all team members within the project. The projectmanagers will have to clarify the roles and responsibilities ofvarious team members.

The project manager in this project will be in charge of all decisionmaking and judgment until the end of the project. The project leaderwill have to carry continuously out assessments of the project toensure that all partaking’s are as per the required expectations.The project manager is expected to have the general knowledge andunderstanding of the scientific rationale and technical issues thatare associated with the sepsis syndrome and different ways ofeliminating the syndrome.

The project leader will be in charge of planning the best methodthrough which the [project will receive the desired results. Whenplanning, the leader will have to consider time and cost constraints.Re-evaluation of the scheme is also is also the work of the projectmanager. The above ensure that the project sticks to the coreobjectives. Influencing all the key stakeholders in acceptance andparticipation in the project is also the work of the leader. Theinteraction with the managers to ensure adequate resources areavailable is also the function of the project manager. The projectmanagers are responsible for forming, simplifying and providingfollow-up action on matters raised during the meeting. Thecommunicating and sending the required information to the keystakeholders is the work of the project leaders. Through thecommunication, the project is maintained and readjusted to the waylikely to produce the most relevant outcomes. Management of theexternal alliance is also the work of the managers.

Employed Strategies

The strategies that were employed for the project to ensuresmoothness as well as the achievement of the most promising resultsinvolved various measures. The Casper Project formed a team that hadthe duty of developing the guidelines for how the nurses were to carefor the patients with sepsis (Rivero, 2015). Known experts in thefield of care for sepsis patients as well as the elimination ofsepsis were invited to be part of the formation of the guidelines.The individuals in charge of the establishment of the guidelines hadto work in sub-units for one month. The individuals wererepresentatives from most parts of the world. Hence, the healthcareguidelines were exemplary. The healthcare guidelines for sepsisensured that they tackled all the critical areas. This is because allof the recommendations were reviewed by the coordinator as well as anindependent reviewer and sectors that proved to be ambiguousadequately discussed.

For the prevention of the infection, the project first concentratedon education. Educational programs and initiatives were adopted intothe system. Through education, awareness was created on the issuesand the nature of the problem. The project promoted a culture ofpatient safety and individual accountability. The above reduced thecases of sepsis grow into critical stages. Surveillance program forthe detection of nosocomial infection was promoted in the project(AHRG, 2014). Hand hygiene was recommended within the hospitalfacility through different means and method such as the use ofantiseptic hand washing soaps and rubs. Site-specific considerationinvolved the various methods for the elimination and prevention ofrespiratory infections. Elevation of the head of the bed, usage of anendotracheal tube with subglottic secretion drainage in patients,were some of the adopted methods. Several measures were also taken toprevent the central-line related bloodstream infection. There wasalso strategies taken to avoid surgical site infections. For themanagement of the infections, infection control issues wereconsidered, precaution were taken regarding the methods oftransmission of diseases. The adopted strategies were successful inensuring the project become a success (Jones et al., 2015).

Outcomes and SignificanceAchievement of OutcomesCriteria

Casper Project being a nonprofit project, it is essential for theproject leader to carry out a final evaluation. An outcomes-basedevaluation helps with understanding if the organization is carryingout the tasks as expected and as the primary stakeholders are likelyto benefit from. Outcomes should be the benefits to clients fromparticipation in the project. Results of the project evaluated theenhanced learning or conditions that the stakeholders were able togain from the program (AHRG, 2014).

The criteria for the evaluation of the outcomes involved theidentification the main outcomes that are supposed to be evaluated.The mission of the project was reflected on and hence the significantimpacts that were expected of the clients listed (Jones et al.,2015). Afterward, the outcomes that are to be examined were chosenand hence prioritized from the rest. The third step involved thespecification of the observable measures and indicators as thisindicated how successful the project was on the achievement of thekey outcomes.

The target goal of the clients involved was specified, the exactnumber or percentage customers who the project had committed itselfwith for achieving the specific results with was also specified. Thefifth step involved the identification the information that wasneeded for showing the indicators. The program went into intricatedetails of knowing the number of clients that went through with theprogram, how many were able to recover totally from sepsis, how manyremained sick, how the hospital managed to save on resources (Angus &ampPoll, 2013). The program decided on the most efficient way throughwhich the information could be efficiently gathered. This involvedthe documentation, observation of clients and practitioners,questionnaire interviews. Afterward, the final report was analyzedand documented for future use.

Influencing Factors

Outcomes related to limiting sepsis contraction, admission, andreadmission of patients in the healthcare facility acknowledge thepotential hazards that are presented by the illness and theenvironment within the healthcare facility. Nurses are the ones whocan create a healing and conducive conditions through their vigilanceand clinical judgment (Rivero, 2015).

Reports on the success of the project given by nurses play asignificant role in the achievement of the desired goals. Nursesprovided judgments on the physiological changes that are evident in aclient. Additionally, nurses can provide judgments on the presence orabsence of preventable problems and the degree to which care andtreatment aims were accomplished. Nurses monitor and manageinstantaneous therapies by noting trends in physiological changes(AHRG, 2014). Therefore, when a nurse gives a report on the degree ofrecovery of a patient, the feedback is likely to provide the mostoriginal and certain outcome.

The magnitude to which care and treatment intentions are accomplishedwithin the projected period similarly assists as an outcome variable.Nurses are the ones who coordinate the day-to-day exertions of thecomplete multidisciplinary team. The role of the nurses as theintegrator of numerous services is critical for optimal outcomes forreduced cases of admission and readmission due sepsis. A greatgraduation of teamwork and positive interaction between nurses andphysicians is allied with lesser mortality rates, elevation inpatient satisfaction regarding care, and reduced proportions ofnosocomial complications.

Reflection on the Knowledge

The knowledge and skills I learned in my discipline assisted me withthe smooth completion of the project. Effective communicators andteam members within the University helped me in selecting the rightsubject for the project as well as the completion of the project.Providence of a platform for creativity and innovation provided mewith an opportunity of being open-minded in the formation andimplementation of ideas. College equipped learners with competency inculturally diverse and international environments. Having gone to mycollege, I was fitted with the professional skills that assisted mewith the smooth completion of the project.

Significance of Organization and StakeholdersOrganization

The program that has invested in the health of the public lowered thehealthcare costs and insurance drains. The healthcare facilities wereas a result able to use funds for constructive purposes throughconducting more research on other critical issues and the purchase ofa modern form of technology. The program lead to the reduction ofmortality rates from the regions. Clients and the general public wereable to lead healthy lifestyles and as a result, become moreproductive. The hospital was, therefore, able to reduce cases ofcongestion within their facilities due to reduced admission andreadmission of patients due to sepsis. The reputation of healthcarefacilities is also improved as individuals grew more trust on theservices provided by health centers (Angus &amp Poll, 2013). Thehealthcare facilities were able to minimize cases of being sued dueto patients deteriorated health or even deaths.

Stakeholders Nurses

Nurses develop and gain increased skills when it comes to theprovision of better care in term of sepsis. Sepsis acutely andcritically ill patients require heightened vigilance andextraordinarily intricate care from a team of highly skilled healthprofessionals. Therefore, the professionalism of nurses increase inthis field (Martin, 2012). With participation in the program, nursesbecome train and, as a result, gain certification and upgrade intheir care skills. The complexity of healthcare the project is vitalto assure the public that health professionals are competent.


The Casper Project has very high personal benefits to the projectleader. With the success of the project, there are increased andefficient ways for service delivery within the healthcareinstitution. Customer satisfaction becomes enhanced and improved.There is increased effectiveness in the provision of services and theproject leader’s team grows and becomes more efficient when itcomes to teamwork. The project manager becomes more flexible andskill full in carrying out other researchers. The success of theproject provides the leader with increased knowledge on theassessment of risks in the future.


Rehospitalization is a common, expensive, and occasionallylife-threatening event that is connected to gaps in the healthcaresystems. Through this project, it is quite evident that the rate ofrehospitalization can be abridged with the implementation ofadditional secure systems. This research has been able to eliminatethe misconception that rehospitalization rate is repeatedly presentedas a relation to the performance of hospitals. This research provesthat rehospitalization is also an indicator of the performance of ourhealth care system. The project was a success in the achievement ofits core objectives which involved the reduction of admission andreadmissions in hospitals due to sepsis syndrome. The researchfocused itself on the analysis and study of sepsis. In conclusion,therefore, reducing hospitalizations of patients from a nursing homeor hospitals is important. The reduced hospitalization andrehospitalization is likely to improve quality of care for residentsand hence save money


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