Abstract 239: Impact of Nurse Practitioner Directed Comprehensive Heart Failure Program in the Clinical Decision Unit

Abstract

Background: Hospitalization due to acute heart failure (HF) is a leading cause for admission and a major source for healthcare dollar expenditure. Clinical decision units (CDU) in the emergency department (ED) have been increasingly utilized by hospitals to prevent unnecessary HF admissions. If post CDU discharge and follow up care is suboptimal, there is increased likelihood for repeat ED visit and/or admission.We conducted this study to prove that a nurse practitioner (NP) directed intervention consisting of HF specific education coupled with timely outpatient clinic follow up will reduce repeat ED visit and/or 30 days readmissions. Methods: A retrospective chart review of HF patients admitted to the CDU using a prespecified protocol from 1/2013-12/2013 was performed. The patients were divided into two groups, those seen by the HFNP in the CDU (intervention group) vs. those not seen by HFNP (the control group). The intervention consisted of face-to-face heart failure education, medication optimization, symptom management; follow up phone call within 24-48 hours and heart failure clinic follow up 1-3 days post CDU discharge. Outcomes variable were repeat ED visits and/or readmissions within 30 days. Descriptive statistics and Chi-square were used for data analysis. Results: 160 patients were admitted to the CDU using the heart failure protocol. 15 patients were found not to have heart failure and excluded from the study. Of the 145 heart failure CDU patients, 33 required admission and were not included in further analysis. The final study population was 112 patients, with 85 patients receiving the intervention. The mean ages for the intervention and control groups were 57.2 vs 55.9. There were 11 admissions (13% all cause) in the intervention group within 30 days following CDU discharge and 5 (6%) were HF related after adjudication. For the control group, there were 7 admissions (26% all cause) and 6 (22%) heart failure related. The difference in all cause 30 day admissions was statistically significant (p = 0.035). Conclusion: NP directed intervention in the CDU significantly reduced ED visit and 30 days readmission. Further studies are required to fully investigate this findings and potential impact on health care expenditure.