Abstract P142: A Statistically Significant Reduction in Heart Failure Length of Stay: Moving the Mean Through Process Improvement

Abstract

Background: The burden of acute heart failure (HF) remains formidable. Length of stay (LOS) must be minimized to control costs, while still maintaining positive outcomes. Inappropriate diagnoses and the lack of coordinated care remain impediments to achieving a target LOS. Care process redesign affords an opportunity to improve LOS. Method: The HF program at Christiana Care Health System implemented a process improvement (PI) project in June 2009 on our 31 bed heart failure unit (HFU) to identify and correct barriers to timely discharge. Markers for increased LOS were identified based on historical data and included: O2 use, skilled nursing facility referral, IV vasoactive therapy use, absence of ACC/AHA guideline-based HF therapy, multiple co-morbidities, poor social support and depression. The HFU multi-disciplinary team engaged the nursing staff in twice daily case review rounds to identify and remedy outstanding care issues. The HFU team was proactive and developed individual care plans. Social Work and Case Management addressed options for the transition to home (+/- home healthcare), rehabilitation, or extended care. A HF Clinical Psychologist was consulted for patients with depression and/or poor social support. Providers were engaged where ACC/AHA HF guideline and HF Core measure compliance was lacking or when prolonged O2, IV diuretics, or IV vasoactive drug use was identified. Results: LOS on the HFU (6 months Pre and Post project initiation) was compared via Student's t-Test for unpaired data. PI Project implementation resulted in LOS reduction of 0.86 days. Pre vs post project initiation: p= 0.028. (See Table ). Conclusion: A dedicated multi-disciplinary team, rounding twice daily on HF patients in a dedicated HFU, was able to significantly reduce LOS through the systematic identification of barriers to a timely discharge, and application of targeted interventions in a large volume medical center. Christiana Care Health System Heart Failure Unit Time Period HF Admissions Male Female Mean Age LOS LOS Range Pre- PI Project Intervention Dec ’08 - May ’09 358 45.00% 55.00% 73.3 yrs 6.24 ± 0.49 5.42 - 6.90 PI Project Intervention Jun ’09 - Nov ’09 346 51.00% 49.00% 72.9 yrs 5.38 ± 0.66 4.55 - 6.20 Pre versus Post PI Project Intervention LOS: p= 0.028