Abstract 270: Reduction in 30-day Heart Failure Readmissions

Abstract

Heart failure (HF) 30-day readmission after hospitalization continues to have a significant clinical and economic burden and hospitals are seeking methods to prevent these readmissions. We tried many projects to reduce heart failure readmissions without much success. After much analysis we found that preventable readmissions occur early. Our hypothesis was that the “defect” is in-hospital or in transition at discharge. This idea led to a pilot study to reduce HF readmissions. A paper based checklist was created, utilizing a patient-centered approach to the delivery of care to optimize clinical outcomes. This checklist included in-hospital care metrics which were reinforced at various times throughout the patient’s hospital stay to ensure discharge readiness. A multi-disciplinary team: nursing, physician/LIP, pharmacy, nutrition and care management were responsible to address the following measures: Medication reconciliation Diet compliance Importance of follow up care Standard physician care Addressing quality metrics We implemented this pilot study on one nursing unit and limited the use of the checklist to two physician/LIP service groups. We used an intention-to-treat analysis approach and included concurrent and historical data to determine effectiveness of the HF discharge checklist. Data for the pilot study was from the index discharge date starting April 1, 2013 to June 22, 2013. The HF readmissions for 2013 were compared to the heart failure readmissions for 2012, using the same time period April 1 to June 22. We also filtered to the physician service group in the previous year (2012) for comparison. Heart failure readmission rates in all primary and secondary HF diagnosis patient population using the checklist were very positive with results at 14.6% (12 of 82). This was compared to the previous year (2012) using the selected physician group and found the readmission rate was 26.5% (18 of 68). Heart failure readmission rates for the hospital population were 18.7% (67 of 358) in 2013, compared to 24.5% (83 of 339) in 2012. Heart failure readmission rates on the selected nursing unit, including both patient populations with and without the checklist, were 20% (29 of 145) in 2013 vs. 25.2%927 of 107) in 2012. The use of the paper based checklist was a success to reduce heart failure 30 day readmissions.