PICO(T) is a framework commonly utilized in evidence-based practice to create focused clinical questions and guide the search for relevant research evidence. By dividing a clinical scenario into its essential elements, PICO(T) enables health professionals to formulate specific and answerable questions that address vital aspects of patient care. Each element of PICO(T) (patient/population, intervention, comparison, outcome, and time) represents a critical aspect of the clinical question and helps define the focus and scope of inquiry. Specifying these elements, therefore, allows health professionals to refine their search for evidence and determine studies that directly address the clinical question. In the context of patients with congestive heart failure (CHF), PICO(T) questions can be created to explore the effectiveness of different interventions, compare treatment options, or evaluate the impact of particular factors on patient outcomes. By following the PICO(T) framework and adopting an evidence-based approach, healthcare providers can improve the quality of care for patients with CHF. In addition, the approach supports the utilization of interventions that have been comprehensively studied and proven to be effective, eventually enhancing patients’ outcomes and optimizing their management.
Use of the PICO(T) Approach when Caring for Patients with Congestive Heart Failure
The practice issue to be explored using the PICO(T) approach is the need to develop care practices that aid in reducing hospital readmissions for patients with congestive heart failure. The question being explored is: Does the multidisciplinary care approach, compared to usual care by a single health provider, improve patient outcomes (such as decreased hospital readmissions) in patients with congestive heart failure?
The multidisciplinary approach has been recognized as the intervention strategy as it entails coordination and collaboration among healthcare professionals from various specialties to provide holistic and comprehensive care for patients with CHF. This approach recognizes patients’ needs and their complex medical conditions and thus requires input from different healthcare disciplines to optimize outcomes (Rao et al., 2022). A multidisciplinary approach stresses the importance of communication, collaboration, and technology is delivering patient-centered and comprehensive care for patients with CHF. The population being examined are patients with congestive heart failure in emergency departments. As a result, the care practices being explored to address this issue consider factors related to emergency departments.
Identification of Sources of Evidence
It is essential to consider relevant and reliable sources when searching for evidence to answer the PICO(T) question. Journals usually undergo a rigorous peer-review process whereby experts in the field of heart failure review and evaluate the relevance, validity, and quality of the research before publishing. The peer-review process ensures that studies meet particular standards and are based on sound methodology. Journals and reputable databases such as PubMed and CINAHL have set quality control measures ensuring that the information provided is up-to-date, reliable, and accurate. This aids in minimizing the risk of misleading information, errors, and bias. Further, published articles in journals and databases typically explain the study design, research methodology, and statistical analyses used, which allows readers to evaluate the validity of study findings and the strength of evidence. In addition, journals and databases provide access to extensive peer-review evidence such as clinical guidelines, meta-analyses, systematic reviews, and original research studies, hence making them more credible and reliable sources of evidence.
In order to answer the PICO(T) question, systematic reviews and meta-analyses compile and analyze existing research on congestive heart failure and provide a summary of available evidence. Reviews and meta-analyses are valuable sources for gaining a comprehensive overview of the current literature on CHF and evaluating the overall strength of evidence. Clinical practice guidelines are developed by professional societies or reputable organizations and provide evidence-based recommendations and interventions regarding CHF. Also, randomized controlled trials (RCTs) are considered valuable in clinical research. They entail randomly assigning study participants to different interventions or control groups and evaluating the outcomes. Randomized controlled trials provide strong evidence for assessing the effectiveness of interventions and comparing various treatment approaches for patients with CHF. Analyzing sources from journal articles and databases enable this research to evaluate evidence and findings from sources to provide an answer to the formulated PICO(T) question about CHF.
Findings from Articles
Care approaches for CHF are based on evidence-based practices, particularly from systematic reviews and meta-analyses. Such reviews and analyses have been subjected to rigorous scrutiny to determine their effectiveness in different practice environments. A multidisciplinary approach is more effective in improving patient outcomes, such as decreased hospital readmissions compared to usual care by a single health provider. This effectiveness is endorsed by Rao et al. (2022), who focus on the importance of an integrated and collaborative approach among cardiologists, social workers, pharmacists, and nurses to improve patient outcomes and reduce the likelihood of readmissions among patients. Patients with CHF have a mean length of hospital stay of five days in the U.S. During this time; a multidisciplinary care team has numerous opportunities to intervene in and enhance the clinical trajectory of heart failure. In the emergency department, each stage of care, including decongestion and stabilization, monitoring, and discharge, presents an opportunity for care coordination and shared decision-making (Rao et al., 2022). Study findings indicate that the contribution of a multidisciplinary team is essential in managing CHF, and their participation in dietary interventions, medication management, patient education, psychological support, and exercise programs is vital in minimizing hospital readmissions within 30 days period.
According to Nair et al. (2020), remote monitoring and telehealth by a multidisciplinary team can help monitor heart failure patients remotely, facilitating early detection of clinical deterioration, improved management, and timely intervention without requiring hospital readmission. Findings from the study revealed that quality improvement initiatives like a post-discharge follow-up, optimizations of guideline-directed medical therapy, medication reconciliation, and patient education led to a significant decrease in hospital readmission in a 30-day period. This improvement can be attributed to multidisciplinary efforts in transitional care for patients with CHF. Further, Wood et al. (2019) focus on the importance of discharge education and planning by ensuring effective communication and collaboration among multidisciplinary teams and patients. This involves providing comprehensive discharge instructions, fostering communication with primary caregivers, scheduling follow-up appointments, and medication reconciliation. While addressing the factors contributing to readmissions, the multidisciplinary approach also entails fostering patient engagement in self-care management to reduce 30-day readmissions.
Furthermore, to minimize unplanned readmissions, patient education, and self-management strategies are necessary. This includes providing structured patient education programs that empower individuals with CHF to better understand their condition, follow lifestyle and dietary recommendations, adhere to medication regimens, recognize heart failure symptoms, and manage fluid balance (Diamond & DeVore, 2022). By enhancing patients’ self-care knowledge and skills, they are better prepared to prevent exacerbations and recognize the need for early interventions. Findings acknowledge the role of a multidisciplinary approach in various therapeutic approaches, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, sacubitril/valsartan (ARNI) therapy, and other emerging pharmacological treatments in minimizing CHF readmissions. Additionally, a systematic review and meta-analysis conducted by Raat et al. (2021) examined the role of primary care in multidisciplinary care models of CHF. Various outcomes were analyzed, including length of hospital stay, hospital admissions, mortality rates, costs, and emergency department visits. Integrating primary care within multidisciplinary heart failure management resulted in efficient use of healthcare resources and improved patient outcomes, including decreased hospital readmissions.
This paper relied on findings from related searches regarding a multidisciplinary approach to improving outcomes for patients with CHF. Most studies had an intervention period of 30 days, although others had no definite period. Based on the PICO(T) framework, there is significant evidence supporting a multidisciplinary approach for reducing hospital readmissions for patients with congestive heart failure.
Relevance of Findings from Articles
The study by Diamond & DeVore (2022) was selected since it provides novel strategies for preventing rehospitalizations for CHF. The study discussed various challenges related to heart failure readmissions and provided an outline of evidence-based approaches and interventions that can be adopted to minimize such rehospitalizations. In different healthcare settings, a multidisciplinary care approach can reduce CHF readmissions through transitional care programs, telehealth interventions, remote patient monitoring, patient education, optimizing guideline-directed medical therapy, and patient self-management programs. By reviewing the current literature and exploring the mentioned strategies, this study provides valuable insights into effective interventions and approaches to minimizing hospital readmissions among CHF patients.
Raat et al. (2021) conducted systematic reviews and meta-analyses to evaluate the impacts of various care models and the involvement of primary care in heart failure management. This study was selected as such reviews and meta-analyses comprised randomized controlled trials published in Cochrane, Embase, and MEDLINE between 2000 and 2020, using the Cochrane Collaboration methodology. Besides, the meta-analysis comprised 19 RCTs, where 13 were from hospitals, and 6 were in the community. Raat et al. (2021) review found that a multidisciplinary approach that involved primary care positively impacted CHF management. Besides, the collaboration between cardiologists and other physicians improved outcomes like decreased hospital readmissions.
From the review of these two sources, findings from Raat et al. (2021) emerge to be the most credible. Their systematic reviews and meta-analyses adhere to the Cochrane Collaboration methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In addition, studies included in the reviews and meta-analyses have been assessed for quality and risk of bias using criteria outlined by the Cochrane Handbook for Systematic Reviews of Intervention. Moreover, the overall quality of the evidence supporting the outcomes has been evaluated using the Grading Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Conclusion
The prevention of hospital readmissions among patients with CHF can be achieved after implementing suitable evidence-based interventions. The PICO(T) approach was used in determining whether the multidisciplinary care approach was more effective compared to the use of a single care provider by specifying evidence sources, explaining findings, and assessing the relevance of such findings. Studies by Diamond & DeVore (2022) and Raat et al. (2021) provide credible and relevant information to sufficiently examine the efficacy of the multidisciplinary care approach.
References
Diamond, J., & DeVore, A. D. (2022). New strategies to prevent rehospitalizations for heart failure. Current Treatment Options in Cardiovascular Medicine, 24(12), 199–212. https://doi.org/10.1007/s11936-022-00969-y
Nair, R., Lak, H., Hasan, S., Gunasekaran, D., Babar, A., & Gopalakrishna, K. V. (2020). Reducing All-cause 30-day Hospital Readmissions for Patients Presenting with Acute Heart Failure Exacerbations: A Quality Improvement Initiative. Cureus, 12(3), e7420. https://doi.org/10.7759/cureus.7420
Raat, W., Smeets, M., Janssens, S., & Vaes, B. (2021). Impact of primary care involvement and setting on multidisciplinary heart failure management: A systematic review and meta-analysis. ESC Heart Failure, 8(2), 802–818. https://doi.org/10.1002/ehf2.13152
Rao, V. U., Bhasin, A., Vargas, J., Jr, & Arun Kumar, V. (2022). A multidisciplinary approach to heart failure care in the hospital: Improving the patient journey. Hospital Practice (1995), 50(3), 170–182. https://doi.org/10.1080/21548331.2022.2082776
Wood, R. L., Migliore, L. A., Nasshan, S. J., Mirghani, S. R., & Contasti, A. C. (2019). Confronting challenges in reducing heart failure 30-day readmissions: Lessons learned with implications for evidence-based practice. Worldviews on Evidence-Based Nursing, 16(1), 43–50. https://doi.org/10.1111/wvn.12336
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