Since the implementation of the Affordable Care Act (ACA) in 2012 and the Hospital Readmission Reduction Program (HRRP), hospitals and organizations have been encouraged to improve care coordination to reduce the number of avoidable readmissions (CMS, 2020). Three of the six publicly reported condition or procedure-specific 30-day risk-standardized unplanned readmission measures in the HRRP are cardiac-related: heart failure, acute myocardial infarction, and coronary artery bypass grafting (CMS, 2020). Although guidelines call for structured follow-up in patients with cardiac diagnoses after a hospital admission, just over half of admitted patients are being scheduled for follow-up (Goyal et al., 2016; Heidenreich et al., 2020). The proposed change in clinical practice involves standardization of follow-up care among adult cardiac patients through proactive scheduling of follow-up appointments. Studies identified demonstrate improved outcomes related to hospital readmissions, patient satisfaction, patient-rated quality of life, and mortality as a result of the implementation of standardized follow-up. Analyzing the relationships between EBP knowledge and patient outcomes is essential to the successful delivery of care. The rationale for this project is supported by a significant body of evidence. The body of evidence discovered through the systematic search and synthesis supports the recommendation for standardized follow-up care for cardiac patients. Overall, hospital readmissions threaten the health and quality of life of patients with chronic diseases (McHugh & Ma, 2013). Moreover, unnecessary hospital admissions drive costs for the organization while increasing the risk of mortality. There is an opportunity to eliminate variations in discharge practices and improve patient outcomes through standardization of follow-up care for all cardiac patients (Goyal et al., 2016). All care providers in the organization should be unified in prescribing follow-up care based on the individual needs of the patients and the corresponding primary diagnoses.

Date of publication

Fall 11-21-2021

Document Type

MSN Capstone Project



Persistent identifier



Master of Science in Nursing Administration

Included in

Nursing Commons