Impact of a Guidelines-Based Educational Program on Heart Failure Readmissions to a Medical Teaching Service

Abstract

Introduction: The literature supports successful reductions in readmissions and improved outcomes with nurse practitioner (NP)-led outpatient HF programs, however readmission rates in the U.S. have remained at 25% for the past decade. Little is known, however, about the impact of an inpatient NP-dedicated program facilitating the management of HF patients directed at advanced HF (NYHA class IIIIV). This study assesses the initiation of an inpatient NP-led HF program and the resulting readmission, mortality, and hospice referral rates Hypothesis/Aim: To review the impact of a comprehensive inpatient NP led HF program that included a rapid patient referral service to a heart transplant/ left ventricular assist device (LVAD) center. Methods: A retrospective cohort record review of HF patients admitted to a regional hospital within a large hospital system in north Texas. An inpatient NP-led HF program was initiated that included clinical management, patient/staff education, discharge programming, hospice and tertiary center referrals. All-cause readmission, mortality, and hospice referral rates for patients admitted with a primary diagnosis of HF from December 2011-January 2013 were assessed via the hospital’s electronic medical record system. Readmission rates and outcomes for advanced HF patients referred to a tertiary HF transplant/LVAD program within the same hospital system were also assessed. Results: From December 2011-January 2013, there were 651 patients with a primary diagnosis of HF admitted. The 30 -day readmission rates from December 2011-February 2012 ranged from 19-22%. The HF program was implemented in February 2012. Readmission rates began to trend downward and remained at or below 15% starting in March 2012-January 2013. Mortality rates remained unchanged at 3.5%, Hospice referrals however increased from 3% in 2011 to 7.9% in 2012. Eleven (NYHA class III-IV) HF patients deemed appropriate for advanced HF treatments were referred to the tertiary transplant/LVAD center starting in March 2012. Three patients were successfully transplanted within an average of 5 months of transfer date. Additionally, 1 patient was successfully implanted with an Heartmate II LVAD within 1 month of transfer. The 30-day readmission rate for this patient subset was 20% prior to referral and there were no 30day readmissions post referral. The mortality rate was 27%. Conclusions: After the implementation of this NP HF program there was a O4-7% decrease in 30-day readmission rates. These programs should continue to be evaluated in their ability to reduce HF readmissions.