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Evidence-Based Practice PITCO Question

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PICOT question examines whether a nurse’s application of the LACE scoring index and the Intervention to Reduce Acute Care Transfers (INTERACT) reduces a patient’s readmission in the Skill Nursing Facilities (SNF) and improvement of transition care compared to the non-utilization of the LACE scoring and INTERACT tool. This paper will examine the PICOT question while providing evidence, methodology, and evidence in detail.



Evidence-Based Practice PITCO Question


Rehospitalization of patients is a common issue among hospitals, SNFs, and medical patients. According to Mileski et al., 2017, the majority of the adverse effects leading to patient rehospitalization are preventable. Additionally, among older SNF patient’s fragmentation of care is a risk factor that increases their vulnerability (Wang et al., 2014). This project utilizes the Transition Of Care Model (TCM) to complement the evidence-based protocol approach used to assess the transition of care for patients released from hospices to SNFs. This paper focuses on the efficiency of the LACE and INTERACT tool on (a) the alertness of staff’s nurses to the alteration of a patient’s condition in Advance Practice Provider (APP) to diminish rehospitalization as compared to the non-utilization of these tools (b) improving attention given to high-risk patients by staff nurses.

Clinical Question

The frequency of hospital readmissions occurs within the 30 days of hospital discharge. While working in SNF, treating recently discharged patients from hospitals, I realized the majority have several comorbidities and are frail. Consequently, SNFS nurses fail to timely report alterations in a patient’s health status, thus leading to the high readmission rate (Enderlin et al., 2013). The readmission rate of discharge patients to SNF is 20-25 percent. Furthermore, the SNF lacked a transitional care model which will identify high-risk readmission patients through sign and symptoms, for a timely APP report.

LACE index scoring tool is a strategy used to reduce readmission by identifying preventable readmission. Moreover, it identifies possible deaths within 30 days based on four parameters. The four parameters include (i) L for the length of stay (ii)A is the acuity of admission (iii) C is the comorbidities’ integrating the Charlson comorbidity catalogue and (iv) E is the total sum of emergency appointments within the preceding six months.  In several studies, a higher LACE index reflects a higher patient readmissions rate (Kripalani et al., 2019). To assist older patients in achieving successful care transition, nurses specialize in the care and systematic approach to meet family and patient cognitive, sensory needs, and health literacy. In other words, the systematic approach minimizes unnecessary death and rehospitalization.

The PICOT query is “does the use of LACE and INTERACT tools over a period six months reduces the patient’s readmission rate and advance the transition of care amongst patients admitted in SNFs as compared to patients the non-utilization of the INTERACT and LACE tool. According to a quasi-experimental study, the results revealed that nurse transition care coordinators’ interventions helped to reduce health care costs between the 30 to 90 days period (Kripalani et al., 2019). Mileski et al., 2017) states that the transition of care is effective in the reduction of health care costs and patient rehospitalization between 30 to 90 days period.

Utilizing the INTERACT tool has several advantages, such as resolution and early recognition of fluctuations in elder patients well-being status. In doing so, there are limitations to the potential complications, rehospitalization, and ever-increasing healthcare costs.




Enderlin, C. A., McLeskey, N., Rooker, J. L., Steinhauser, C., D’Avolio, D., Gusewelle, R., & Ennen, K. A. (2013).  Review of current conceptual models and frameworks to guide transitions of care in older adults. Geriatric Nursing, 34(1), 47-52. doi:10.1016/j.gerinurse.2012.08.003

Kripalani, S., Chen, G., Ciampa, P., Theobald, C., Cao, A., McBride, M., Dittus, R. S., & Speroff, T. (2019). The transition care coordinator model reduces hospital readmissions and costs. Contemporary Clinical Trials, 81, 55-61. doi:10.1016/j.cct.2019.04.014

Mileski, M., Topinka, J. B., Lee, K., Brooks, M., McNeil, C., & Jackson, J. (2017). An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: A systematic review. Clinical Interventions in Aging, 12, 213-222.  doi:10.2147/CIA.S123362

Wang, H., Robinson, R. D., Johnson, C., Zenarosa, N. R., Jayswal, R. D., Keithley, J., & Delaney, K. A. (2014). Using the LACE index to predict hospital readmissions in congestive heart failure patients. BMC Cardiovascular Disorders, 14(1). doi:10.1186/1471-2261-14-97




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