Abstract
Background and Significance: Congestive heart failure CHF) is a common, chronic disease that significantly impacts patient outcomes, efficient patient management and health care economics. At a two site hospital corporation in Ontario, Canada, CHF is one of the top admission diagnoses and leading outlier in terms of length of stay (LOS) and conservable days. In the fiscal year April 1, 2012 to March 31, 2013, quarterly audits demonstrated poor compliance with CHF pathway and standardized order set use. Aim: Mixed method study/quality initiative to review CHF pathway use and determine if heart failure pathways decrease LOS, conservable days and leverage organization efficiencies. Methodology: A mixed methods approach was taken.: 1) staff surveys to identify CHF pathway awareness and barriers to use, 2) Secondary data analysis on a) site specific chart audits of CHF pathway/order set compliance b) CHF admission/discharge data to examine LOS, expected length of stay (ELOS), and conservable days. Data Analysis/Results: Pearson’s chi-square determined responses to question 5 (use CHF pathway regularly) were statistically significant between sites, χ2 (1) = 7.07, p = .008, with 54.1% of Site 2 respondents indicating yes compared with 21.4% of Site 1 respondents. Tests of ANOVA revealed no significant differences between patient age or ELOS between sites. Actual LOS was significantly different between sites, F (1, 498) = 6.20, p = .013, with average LOS at Site 1 (M = 10.05 days, SD = 9.32 days) greater than Site 2 (M = 7.73 days, SD = 11.03). An ANOVA with site as independent variable and conservable days as dependent variable, revealed significant difference between sites, F (1, 498) = 7.78, p = .006, with Site 2 reporting a statistically significant decreased number of mean conservable days (M = -1.15, SD = 4.59) compared with Site 1 (M = .08, SD = 5.23). All analyses were conducted with SPSS, Version 22 (IBM Corp., 2013). Conclusion/Implications: This study provided some evidence that CHF pathways may decrease LOS and conservable days and leverage organization efficiencies. This has the potential to be of critical significance to an overburdened health care system and further research should be undertaken. These results must be interpreted with caution as the reliance on secondary data analysis and survey responses prevents the determination of causation.
Highlights
Significance and JustificationCongestive heart failure (CHF) or heart failure (HF) is a chronic, complex disease that places a significant global burden on health care
Conclusion/Implications: This study provided some evidence that CHF pathways may decrease length of stay (LOS) and conservable days and leverage organization efficiencies
The negative value is an indication that the patients actual LOS was less than the Expected Length of Stay (ELOS) assigned to the admission
Summary
Congestive heart failure (CHF) or heart failure (HF) is a chronic, complex disease that places a significant global burden on health care. Patients with heart failure are challenged by threats to their quality of life and face significant morbidity and mortality. In Canada, heart failure affects approximately 500,000 Canadians with 50,000 new patients diagnosed each year [2]. The impact of heart failure on health care economics is staggering. Heart failure accounts for approximately two percent of expenditures and in the United States the costs associated with heart failure hospitalizations reached an estimated $20.1 billion dollars in 2009 [3]. It is projected that in the United States, by the year 2030, the total cost of heart failure to the health care system will reach $70 billion dollars [4]
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