Qualitative Research Critique and Ethical Considerations
Hospital readmissions after orthopedic surgery have become an issue of concern for most hospitals and reducing these rates is a priority and a benchmark of healthcare quality in the USA (Ramaswamy et al., 2019). This paper focuses on the appraisal of qualitative research on the topic of readmissions rates for patients who have undergone orthopedic surgery. This paper is based on two articles; by Tsai et al., (2013) and Saunders et al., (2021).
Background of Study
The article by Tsai et al., (2013) focuses on reducing hospital-readmission rates which is a priority for both clinical leaders and policymakers. This study aimed at a qualitative exploration of whether the variations experienced in the readmission rates after major surgeries were due to other measures of quality surgical care or the discharge process and implementation. It compared the characteristics of patients who were readmitted within 30-days after discharge to those of patients who were not readmitted within the 30-day period as well as the characteristics of those hospitals that had composite readmissions rates above the median to those hospitals that had rates below the median. This study was driven by the belief that reducing the rate of hospital visits can improve care and lower costs. Three research questions drove the study were;
- What are the patterns of surgical readmissions among Medicare Patients across a set of major procedures?
- Are key hospital’s structural characteristics such as size or teaching status, associated with higher surgical readmission rates?
- To what extent is a hospital’s performance on well-established measures of surgical quality correlated with its surgical-readmission rate?
Having established the gap and the research problem, the authors established the significance of this study by seeking to identify to what degree the readmission rates related to the hospital quality.
The article by Saunders et al., (2021) focuses on the discharge experiences of patients after orthopedic surgery. It explores the roles of nurses and other professionals in the provision of discharge information to meet the individual patient needs including obtaining patient feedback, medication management, wound care, and prevention of constipation as part of recovery. The purpose of this study was to explore the experiences of patients after discharge following orthopedic surgery because insufficient discharge education can lead to readmissions. The research question driving this study was “What are the orthopedic patients’ discharge experiences or discharge information needs that can directly inform the best discharge education practice?’. The significance of this study is that it provides an understanding of the importance of discharge education as a part of patient care and how it can reduce the rates of readmissions by understanding the discharge information needs.
Method of study
In the article by Tsai et al., (2013), three data sources were linked from the 2009 Medicare Inpatient 100% file and 2010 Medicare Provider Analysis and Review (MEDPAR) File, the American Hospital Medicare (AHA) annual survey on hospital characteristics, and Hospital Compare Data, including Hospital Quality Alliance (HQA) Surgical Care scores. The focus was on patients undergoing an of the six major common surgical procedures: coronary artery bypass grafting (CABG), pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement. The researchers calculated readmissions rates 30 days after discharge. Bivariate and multivariate models were used to establish the association between hospital structural characteristics and readmission rates at 30-days.
Despite establishing the association between readmission rates and measures of surgical quality, it is important to note that more factors affect readmission rates. Patient-level factors such as age, gender, ethnicity, presence of comorbidities, are independent risk factors for postoperative complications and readmissions (Lehtonen et al., 2018).
In the article by Saunders et al., (2021), the study utilized a descriptive qualitative design whereby 34 interviews were conducted via telephone following a semi-structured question guide which was informed by literature review. The interview consisted of 8 questions related to the discharge process, verbal or written communication provided at discharge, and if the information was useful in recovery. The interview recordings were transcribed by one member of the research team and analyzed by two different researchers. A qualitative thematic analysis approach was adopted while descriptive statistics were calculated using SPSS. The study highlights the roles of nurses in the discharge process and insights from the patients are important. However, the study is conducted in one acute-ward in a private hospital site, hence making the findings here bias as the outcomes cannot be generalized.
From the study by Tsai et al., (2013), it was found out that approximately one in seven patients discharged after undergoing a major procedure is readmitted within 30-days with some variations across the hospitals. Hospitals with high performance in terms of procedure volumes and 30-day mortality rates had lower surgical-readmission rates than other hospitals. This is because hospitals with higher volumes of procedures are better equipped in preventing postoperative complications. All these findings are evidence that surgical-readmission rates are associated with measures of surgical quality (Tsai et al., 2013). These findings should offer reassurance to policymakers who wish to use surgical-readmission rates to grade and pay hospitals. It is also useful in nursing practice when they want to rate the quality of care and surgical performance in their hospitals.
From the analysis by Saunders et al., (2021), patients’ discharge experiences were apparent in three themes.
- Their experiences of the discharge process including how information was provided, time for preparation, and family support.
- Patients’ perception of discharge information i.e is how the information provided helped in recovery.
- Limitations of discharge information. It was found that a written communication during discharge and some verbal affirmations went a long way in the recovery process.
The findings highlighted the need for a standardized discharge plan which should also be individualized according to the patient’s unique needs. The feedback from the patients contributes greatly in making changes by the nurses to improve discharge education and the discharge process (Saunders et al., 2021)
The study by Tsai et al., (2013) was approved by the Office of Human Resource Administration at the Harvard School of Public Health. Since the data was administrative data captured from the billing codes, Informed Consent was deemed unnecessary by the institutional review board.
The study by Saunders et al., (2021), involved human research thereby, ethical approval was granted for it as a scientific research study. The submitted manuscript was subjected to a full review by the Hollywood Private Hospital Research Ethics Committee, approval number HPH530. Reciprocal ethical approval was obtained from Edith Cowan University Human Research Ethics Committee. Participants gave verbal consent to be part of the study as interviews were the mode of data collection.
Order a Custom Solution
Lehtonen, E. J., Hess, M. C., McGwin, G., Shah, A., Godoy-Santos, A. L., & Naranje, S. (2018). Risk factors for early hospital readmission following total knee arthroplasty. Acta ortopedica brasileira, 26, 309-313.
Ramaswamy, A., Marchese, M., Cole, A. P., Harmouch, S., Friedlander, D., Weissman, J. S., … & Trinh, Q. D. (2019). Comparison of hospital readmission after total hip and total knee arthroplasty vs spinal surgery after implementation of the hospital readmissions reduction program. JAMA network open, 2(5), e194634-e194634.
Saunders, R., Dineen, D., Gullick, K., Seaman, K., Graham, R., & Finlay, S. (2021). Exploring orthopedic patients’ experiences of hospital discharge: Implications for nursing care. Collegian.
Tsai, T. C., Joynt, K. E., Orav, E. J., Gawande, A. A., & Jha, A. K. (2013). Variation in surgical-readmission rates and quality of hospital care. New England Journal of Medicine, 369(12), 1134-1142.