Reducing Readmissions: One Heart Failure Patient at a Time

Abstract

Program Structure and Population The purpose of this abstract is to summarize our journey of adopting a nurse practitioner led cohort program with certified heart failure nurses and the effects on WVU Hospital’s heart failure readmission rates. WVU Hospital is a rural 531-bed tertiary care referral center and serves as the primary academic center for WV University’s health profession schools. According to the National Vital Statistics Report, 2009, more than 1 out of 4 deaths in West Virginia were due to heart disease (25.7 percent of total deaths). Strategies Our strategies include the development of a nurse practitioner led collaborative team that meets daily, a cohort floor with Certified Heart Failure Nurses (CHFN), an extensive in-patient education process, teach back evaluations, medication reconciliation with a pharmacist as needed, personalized phone calls, and a specific discharge plan including a scheduled follow up appointment with the nurse practitioner. We believe having CHFNs on the cohort floor has helped exemplify our dedicated mission and also provides a resource for various health professions. We have recently instituted a diuresis clinic and remote impedance monitoring as part of the outpatient care and developed a free CHF Lifestyle Enhancement Program. Clinical Guidelines As defined by the American Board of Nursing Specialties (ABNS) in its 2005 position paper, "[heart failure]...certification is the formal recognition of the specialized knowledge, skills, and experience demonstrated…to promote optimal patient care and according to Delgado-Passler and McCaffrey 2006, they determined that post discharge management by nurse practitioners could improve the quality of care given to heart failure patients. Guidelines set forth by QualityBLUE by High Mark Blue Cross / Blue Shield, Get With The Guidelines (GTWG) by the American Heart Association were utilized to provide optimal care. Data Collection and Evaluation During the first 6 months of 2012, we collected our baseline data and developed our collaborative team. Performance improvement measurements were based on QualityBLUE and GWTG outcomes for decreasing our readmissions for heart failure patients. We continue a dashboard delineating the rates/causes on all cause readmissions to guide our future endeavors. Outcomes The readmission baseline rate was 34.41% for the first 6 months of 2012 which dramatically decreased and has been maintained at a rate of 20.23%. Practice Implications Our findings substantiate the need for using CHFNs to foster the bond of heart failure patient care and management. It is paramount that we get our patients to understand heart failure is not a transient disease but a disease that requires constant attention and by having CHFNs providing care at the bedside helps validate our dedication to their understanding and care management. The outcome data demonstrated a positive reduction in readmissions and therefore is theorized that the nurse practitioner led team had a causal relationship for the patient adhering to our recommendations and having less exacerbations that require hospitalizations. Conclusion The heart failure problem is poised to reach epidemic proportions in the coming years, taking a tremendous toll in the quality and longevity of lives. Moreover, the cost of providing heart failure care ranks among the leading U.S. healthcare expenditures; an estimated $40 billion dollars annually. With the focus being is on readmission rates and reimbursement, having a dedicated heart failure team is essential for decreasing readmissions.