Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 68-year-old man with systolic heart failure (EF 35%) presents with dyspnea, orthopnea, and 8-pound weight gain over two weeks. Vitals: BP 158/94, HR 108, RR 22, SpO2 92% on room air. BNP 450 pg/mL, elevated creatinine 1.8 mg/dL. No peripheral edema noted. He was discharged five days ago after hospitalization. The hospital's 30-day readmission rate is 28% versus the 22% national benchmark. Which intervention has the strongest evidence for reducing heart failure readmissions?
Answer choices
- AComprehensive discharge planning with medication reconciliation, patient education, and follow-up within 7 daysCorrect answer
- BSending patients home with a pamphlet about heart failure self-management
- CScheduling a follow-up appointment at 30 days post-discharge
- DRestricting discharge to weekdays when follow-up resources are available
- ECalling patients once at 14 days to check on symptoms
- FInitiating intravenous diuretics and requiring euvolemia before discharge without early outpatient reassessment
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