CHF Order Set Improves Time to Hospital Readmission

Abstract

Introduction Congestive heart failure (CHF) is the leading cause of hospital readmission, with rates approaching 20% within 30-days and 50% within 6-months. Readmissions account for 43% of Medicare spending at 17 billion dollars yearly. A study by Krive et al in 2014 proved admission order sets were effective, efficient, and decreased inpatient CHF mortality (1.8% vs. 3.2% p=0.034). However, qualitative evidence of the effectiveness of order sets in readmission reduction is lacking. Hypothesis We hypothesized that the consistent use of a protocolized admission CHF Order Sets versus manual order entry will serve to increase time to 30-day readmission for Medicare patients admitted having a primary diagnosis of CHF. Methods A retrospective analysis of CHF patients was performed at WVU from 1/1/16-1/1/18. Readmissions were compared between CHF Order Set and manual order entry groups using Pearson chi-squared and Fishers exact tests. Mann Whitney U Tests were applied to the data due to unbalanced (non-normal distribution) among cohorts. Results The Cardiology service had the highest compliance in use of the order set at 26% with other services averaging less than 7%. The admission CHF Order Set increased the mean number of days to 30-day readmission compared to the manual entry group (12.22 vs. 15.76 days p=0.027). Cardiology providers utilized the order set more frequently for patients with a higher 2017 American Medical College Mortality Risk Score. Conclusions Protocolized admission CHF order sets improves time to hospital readmission. Based on AMC Mortality Risk Score, the CHF order set was proven to be most useful with sicker patients. Limitations faced in this study were limited compliance of order set use and sample size of 1657 between cohorts. Moving forward, there is a need for a mandatory push for order set use and additional analysis to further critique its components based on admission rates and clinician feedback. With decreased Medicare expenditures, millions in admission costs may be saved each year in addition to decreases in hospital-acquired infections and complications.