Rapid Implementation of an Outpatient Multidisciplinary Advanced Heart Failure Team in a Tertiary Academic Medical Center

Abstract

Introduction Unplanned readmissions remain a significant problem for patients with advanced heart failure. The rising cost of healthcare has placed an emphasis on preventing readmissions in this patient population. It has been demonstrated that patients referred to a heart failure disease management program after discharge have lower relative readmission rates. Limited information exists describing the structure and impact of these programs at a tertiary medical center. The purpose of this study is to describe the process for implementing a multidisciplinary advanced heart failure team and its impact on 30-day readmission rates. Implementation of a multidisciplinary advanced heart failure team in a tertiary medical center affords more patients the opportunity to connect with heart failure-trained providers after discharge from the hospital, resulting in significantly fewer 30-day readmissions. Methods A single-center, retrospective electronic medical review was conducted of all patients discharged between January 2016 and December 2017 with an admitting diagnosis of heart failure. Readmissions to the hospital were classified by age, readmission diagnosis, discharging service specialty, discharge location, and time to readmission. The primary outcome was change in 30-day all-cause readmissions after implementation of our multidisciplinary advanced heart failure team. Secondary endpoints included change in 30-day heart failure-related readmissions and percentage of patients who followed up with the advanced heart failure multidisciplinary team. Results The advanced heart failure multidisciplinary team was implemented in September 2017 and consisted of a heart failure-trained dietitian, pharmacist, nurse, and cardiologist. Patients were scheduled to see each member of the multidisciplinary team at their follow-up visit within seven days of discharge. A total of 1,009 patients were discharged from the hospital with a primary diagnosis of heart failure during the study period, with an overall all-cause 30-day readmission rate of 18.4 percent. The number of patients seen per day by our team doubled from five to 10 between September and November. The percentage of patients seen within seven days of discharge increased from 42 percent in September to 78 percent in November. Implementation of a multidisciplinary advanced heart failure team reduced the primary outcome by 3.8 percent. Conclusions Rapid implementation of a multidisciplinary advanced heart failure team resulted in a higher percentage of patients seen in clinic within a week of discharge as well as a reduction in 30-day readmissions.