Abstract 71: Improving the Heart Failure Readmission Rate at an Urban Medical Center

Abstract

Background: Heart failure (HF) is a chronic health condition that affects over 5 million people annually. It is the most common cause of 30-day readmissions with nearly 90% of these readmissions being unplanned. CMS requires hospitals to publicly report 30 day readmission rates for HF with the goal of improving accountability. In 2006, this hospital's 30-day readmission rate was 27% as compared to the national average of 24%. Purpose: To analyze the impact of several quality improvement interventions on 30-day readmission rates for HF at this urban medical center. Intervention: The following interdisciplinary interventions were implemented in the third quarter of 2009: (1) improved nursing discharge education regarding heart failure (ie. sodium restricted diet, medication adherence, daily weight); (2) a detailed medication list was given to patients; (3) patients received an appointment within 2 weeks with an advanced practice nurse (APN) specializing in heart failure; (4) HF patients received their medications prior to discharge; (5) all patients received a follow-up phone call by an APN within 7-10 days of discharge; (6) the hospital billing personnel analyzed patients charts to ensure that HF admissions were being coded appropriately. Methods: Patients were included if their initial admission was coded DRG 428 as their primary diagnosis and were readmitted within 30 days with any diagnosis. Data was summarized into 7, 14, and 30 day readmission rates. Rates were compared prior to the intervention and after. Pearson chi square was used to compare the two groups. Conclusion: At one year, the 30-day readmission rate decreased from 27.1% to 18.2% (p = 0.000) the 14 day readmission rate decreased from 15.1% to 9.1% (p=.003) and the 7 day readmission rate decreased from 8.8% to 5.5% (p=.038). Overall, patients were 1.6 times less likely to be readmitted for HF after the intervention. Recommendations: Hospitals can implement tailored interdisciplinary interventions to decrease their readmission rates. Sustainability of these process improvements will be critical to maintaining a high level of care for HF patients.