Specialized Resident Force in Internal Medicine Residency Program Helps Modify Risk of Heart Failure Readmissions: A Performance Improvement Project

Abstract

Introduction Heart Failure (HF) is a leading cause of hospitalization, mortality and health care costs in the U.S. HF is the most common cause of readmissions in Medicare patients, with >20% readmitted within 30 days of hospital discharge. Several interventions have been tried to lower readmissions involving patient, provider and related disciplines, without significant long-term impact. Hypothesis Development of a specialized team of internal medicine residents trained to educate and counsel HF patients, will enhance disease state knowledge of the disease, improve self-care and reduce hospital readmissions among patients admitted with acute decompensated HF (ADHF). Methods In August 2017, a team of 9 Internal Medicine residents were recruited to create a Specialized Resident Force (SRF). The residents received individual hands-on training sessions in counseling HF patients and met with a mentor weekly initially, later monthly. Patients on 2 selected medicine units with a high volume of HF admissions were counseled by the SRF on diet, activity, medication use, weight monitoring and outpatient follow-up. Demographic data, comorbidities and HF specific data was gathered and compared to patients receiving standard education. Patients were evaluated for cognition and advance directives. In the cognitively impaired, education was offered to the caregiver, if available. A tool was developed to document data; a booklet on HF education and a 2 page easy to use script to help counsel patients at bedside was provided to each resident. Results Enhanced SRF education was provided to 44 patients between September and December 2017. Education provided by the SRF resulted in 55.7% reduction in the 30 day all cause readmission rate (see Table 1 ) Observations by the mentor suggested that knowledge base of SRF trainees improved as a result of participation. Conclusions Specialized internal medicine resident teams providing bedside education to patients with ADHF may favorably influence HF readmissions, while simultaneously enhancing resident knowledge base on HF management; Academic medical centers can easily incorporate resident driven patient education into existing readmission reduction efforts