Graduation Year


Degree Type

Open Access Capstone

Document Type


Degree Name

Doctor of Nursing Practice (DNP)



Download Full Text (2.3 MB)


Baccalaureate and Graduate Nursing

First Advisor

Mary Clements

Department Affiliation

Baccalaureate and Graduate Nursing

Second Advisor

Gina L. Purdue

Department Affiliation

Baccalaureate and Graduate Nursing


Readmission to an acute care hospital are common, costly, and frequently avoidable. Transitions of care are critical to quality, safe patient care and increases effective prevention of readmissions. Although there is an abundance of knowledge related to causes of hospital readmissions and the effectiveness of preventative measures hospital readmission continue to plague healthcare organizations. A review of the literature was conducted, and 11 studies were reviewed and analyzed. The literature review showed evidence to support implementing a telephonic post-discharge follow-up protocol as an effective intervention to reduce hospital readmissions. The purpose of this project was to implement a telephonic, protocol-driven program to reduce 30-day all-cause readmissions. The Coordinated-Transitional Care (C-TraC) Program includes identifying patients that are deemed high risk of readmission based on local facility criteria and providing telephonic follow-up post-discharge from an acute care hospital. Statistical analyses included frequency distribution table for sociodemographic data, previous hospitalization and clinical diagnosis data, and independent t-tests were performed to analyze the differences between the intervention and without intervention group. The result was statistically significant difference in the mean score for the intervention group and without intervention group (p = .012).

IRB Approval Number (if applicable)


Included in

Nursing Commons