Rapid Adaptation Of Televists In The Post Hospital Discharge Heart Failure Clinic: Impact On 30 Day Readmissions During The Pandemic

Abstract

<h3>Introduction</h3> Early follow-up within 7 to 14 days after a hospitalization has been recommended as a measure to reduce 30-day readmission. While the cost of US hospital readmission that is avoidable is estimated at 25 billion per year and the Hospital Reduction Readmission Program (HRRP) was implemented with accountability and penalty on the discharging hospital, the practical aspects of a patient returning within a week back to a clinic has not been addressed. With the surge of Covid-19 pandemic, Televisits have become the norm rather than an exception. We report a single center experience of rapid adaptation of such technology with the onset of the pandemic. <h3>Methods</h3> Deidentified data was obtained from administrative and quality reports of the Houston Methodist Hospital. The Heart failure clinic at our institution is staffed by a heart failure disease management (HFDM) service. Televisit platforms existed in our electronic medical record in the HF clinic in 2018. Heart failure patients would be referred inpatient and scheduled with the HF clinic within 7 days post discharge with a focus on medication reconciliation, self-reported vital monitoring, identification of care resources and barriers to compliance would also be identified during the visit. Plan of care, and changes in the medical regimen were done in collaboration with the patients primary cardiologist. Identified gaps were addressed and referred to community and resources. Community and Home health collaboration were conducted to achieve best outcome and continuity of care. Future appointments were established to ensure follow ups and no gaps in care. <h3>Results</h3> Despite EMR availability of televisit platform in our clinic since 2018, there was no adaptation until the onset of the pandemic. With in-person visits in 2019, the overall all cause readmissions were slightly higher compared to during the pandemic when televisit utilization was to the maximum. As for the HF cause for readmission, the in person visits had a similar slighty lower 30 day readmission rate as compared to the Televisits. <h3>Conclusion</h3> Like in the rest of the areas of outpatient practice, televisit adaptation has been rapid in the HF post discharge clinic. While it seems obvious that many of the logistics and objectives of the post discharge visit can be successfully implemented in a virtual visit, there might be certain limitations like assessing volume status as the HF related readmission seem to have marginally increased.