Heart Failure Re-Admissions: Impact of a Specialized Resident Task Force in Year Two of a Performance Improvement Project

Abstract

Background Heart failure (HF) is a complex disorder that imposes substantial patient burden and entails much health care costs. Nationwide, 30 day re-admissions for HF are tracked and serve as a measure of quality of care. Efforts to minimize HF related hospital re-admissions have generally had mixed results. Hypothesis Development of a specialized, experienced team of internal medicine residents trained to educate and counsel HF patients will enhance their knowledge of the disease, improve self-care and reduce hospital re-admissions in those admitted with acute decompensated HF. Methods In August 2017 a team of 9 Internal Medicine residents were recruited to create a Specialized Resident Force (SRF). The team was expanded to 20 residents in August 2018; they received individual hands-on training sessions in counseling hospitalized HF patients from a mentor weekly initially, later monthly. Patients with HF were counseled by the SRF on diet, activity, medication use, weight monitoring and outpatient follow-up. Demographic data, comorbidities and HF specific data was gathered. Patient's cognition was evaluated. If cognitively impaired, education was offered to caregiver, if available. A tool helped document data; a booklet on HF education, counseling by the resident and a 2 page summary script were offered to patients. Other disciplines (nurse, nutritionist, cardiologist, social worker) had roles in the project. Results Enhanced SRF education was provided to 171 patients with HF between August 2018 and January 2019. Education provided by SRF resulted in declines in 30 day all cause readmissions following index HF admission (Table 1). Observations by mentor suggested enhanced practical knowledge base of SRF trainees as a result of participation. Conclusions A Specialized Resident Force with support from other disciplines helped reduce and maintain low 30 day HF hospital re-admissions consistently over a 6 month period. The project help residents acquire expertise in PI activity while also enhancing their real life experience in managing HF patients.