Abstract 2710: Emergency Room Utilization of Continuous Intravenous Furosemide Together With the American Heart Association Get With the Guideline Heart Failure Care (GWTG-HF) Decreases Length of Stay for Hospitalized Heart Failure Patients at St. Joseph’s Regional Medical Center (SJRMC)

Abstract

The main goals of therapy for hospitalized congestive heart failure (CHF) patients are to achieve euvolemia and to administer optimal standards of care. No study to date has examined ways to implement use of continuous intravenous furosemide (IVF) in the Emergency Room (ER) and ensure that each CHF patient consistently receives optimal standards of care throughout their hospitalization. Therefore, we hypothesized that a multi-disciplinary team approach with coordination of care from ER arrival to discharge (DC) with use of the AHA GWTG-HF Program will decrease length of stay (LOS) and provide optimal care for CHF patients as compared to usual care. METHODS: GWTG-HF was operational in 2006 with a multi-disciplinary team consisting of a Physician Champion, Advanced Practice Nurses (APNs), Case Managers and RNs. In June of 2006 the IVF program was implemented in coordination with the ER, Cardiology and Medicine Departments. ER physicians were prompted by an electronic medical record provider order entry (EMR-POE) CHF order set. GWTG-HF APNs followed these patients throughout their hospitalization. We compared the average LOS of CHF patients who received usual care in 2005 (Group I) to CHF patients who received IVF and GWTG-HF care from 6/06 to 4/07 (Group II). RESULTS: CHF cases in Group I equaled 773 as compared to 212 cases in Group II. Average LOS in I was 6.7 days as compared to 5.5 days in II (p = 0.001). Overall compliance with GWTG-HF Core Measures in 2006 was 98%. CONCLUSIONS: 1. Implementation of IVF in the ER with an EMR-POE order set helps ensure utilization of IVF in the ER at time of admission for CHF patients; 2. A multi-disciplinary team approach with use of IVF along with GWTG-HF is associated with a significant decrease in the LOS as compared to usual care; 3. A multi-disciplinary team approach to care for the CHF patient is superior to usual care with regards to LOS; and 4. GWTG-HF is associated with a high compliance with standards of hospitalized CHF care.