OR6. Heart Failure Hospitalist Program: Innovation Drives Best Practice and Exceptional Outcomes

Abstract

Purpose This presentation will describe a creative, integrated care-model for heart failure (HF) management. Two key areas of focus will be consistent, patient-centered care across the continuum and innovative inpatient strategies. Objectives HF Hospitalist Program objectives have three focuses: • Patient care delivered by a consistent provider resulting in ongoing development of goals of care, resolution of barriers to care and improved patient satisfaction. • Team engagement to coordinate care of high-risk patients, develop plans for transition of care/advanced HF management and consult other interdisciplinary teams. • System opportunities include reduction of 7-day and 30-day readmissions, reduction in length of stay, adherence to HF metrics, and early introduction of Palliative/Hospice. Methods After analysis of HF data by Cardiology and Hospitalist leadership, all parties recognized that consistent inpatient provider care was lacking in the current care-model. The concept of a dedicated Heart Failure Hospitalist service line emerged. Key strategies included: 1) Optimizing care by patient rounds at least twice daily 2) Documentation template to highlight guideline directed therapy, response to treatment and a transition plan (attachment 1) 3) Leading morning huddle and afternoon interdisciplinary rounds 4) Overseeing all non-critical care heart failure admissions in the emergency room and direct admissions 5) Coordinating care with the HF Program manager/Clinical Nurse Specialist and outpatient HF Center to improve metrics such as 5-7 day appointments and 72-hour re-evaluation to assure action plans for yellow day 6) Reducing emergency room utilization by: • Community Paramedicine program referrals for in-home evaluation and administration of IV diuretics • Flagging chronic/high utilizer records • Delivering care in observation units, avoiding costly admissions. Results HF Hospitalist Program and all provider outcomes were compared from 2018-2020. Critical organizational objectives were met. Length of stay for HF hospitalist program was lower by .5 to 1.3 days (see table #1). Guideline directed medical therapy was consistently supported by HF team. Adherence with order set usage, averaged 96.2% for hospitalist team as compared to 81.1% for all providers (see Table #2). Consistent with program objectives to provide compassionate management of end-of-life care and support goals of care discussions, the HF Hospitalist program facilitated more hospice discharges than all providers over 3 years. (see Table #3). All-cause 30-day HF readmission rates were at a system low for all providers in 2018 at 17.22% and currently average 21%. HF Hospitalist team impressively lowered this metric to 9% (2018), 8.34% (2019) and 5.34% (2020). Readmission with HF at 30-days for all providers averaged 7.6%, while the HF Hospitalist team averaged 3.41%. (see Tables #4&5) Conclusions Heart failure is a major health care issue, challenging all medical centers to develop a plan to tackle high prevalence, mortality, and cost of care. This organization's strategy of partnering a HF hospitalist service line with a successful Heart Failure Center, which maintains continuity of care, has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. Attachment #1 Documentation Template Acute on chronic diastolic heart failure (HCC) – (present on admission) Echocardiogram: Chief Complaint: NYHA admission: NYHA current: Device: Etiology for HF exacerbation: Compliance with medications: Compliance with diet: HF order set: BNP on admission: BNP at discharge: Admission Weight: Current Weight: Diuretic (home medication): Diuretic (inpatient): CKD Stage: Cr trend: Urine Output in last 24hrs: NET Output: Current HF medications: -Beta-blocker: -ACEI/ARB/ARNI: -Aldosterone Antagonist: # of Admissions last 6 months: Social Support: Hospice Discussion: TOC Appointment: Heart Failure Hospitalist Outcomes Compared to All Providers 2018-2020 YTD