Heart failure (HF) is the diagnosis responsible for the most hospital readmissions nationally. Our health system has set a performance goal of reducing all 30‐day readmissions for patients insured by Humana to fewer than 16%. This abstract outlines the early stages of a comprehensive HF disease management program focused on readmission reduction.
We began with literature review and interviews with key stakeholders. We followed case managers on patient units and in the emergency department. We analyzed raw data for 2007 Q1 and Q2, provided by Medical Information Systems. We created a model of patient flow to identify leverage points for intervention. The data directed us to focus on 2 areas: revising the patient education materials and formalizing the protocol for referring HF hospital patients to discharge clinic. We incorporated aspects of the change acceleration process (CAP) to fast‐forward the project. We revised existing discharge instructions and created a new clinic referral protocol. We measured our success by monitoring the number of patients referred to clinic each week before and after the protocol was initiated.
The data revealed opportunities. First, LOS of 1 day will be admitted to observation. Second, patients discharged on Sunday had the highest readmission rate, 19.3% (although not the highest volume), indicating a need for strong case management follow‐up. Finally, practices for internal medicine and cardiology should be further standardized, as they share the majority of readmissions. We created a patient flow model that clarified the best way to influence patient behavior while at home would be to focus on educating patients before discharge and by ensuring a prompt clinic appointment to keep them in the HF system. We created new patient education materials and a new clinic referral protocol. Since the release of the protocol, the number of patients referred to the HF clinic increased 300%.
What we began is only a component of a comprehensive disease management program. We plan to develop a telephone management system with phone scripts and to enhance home care services, which will eventually be upgraded to Telecare services. A cardiology fellow involved with this project has taken ownership of creating a HF Unit in the emergency department. This unit could provide space for IV diuretics and ultrafiltration for acute HF exacerbations while avoiding a costly and unnecessary admission. This is a longer‐term goal.
S. Deitelzweig, none.
To cite this abstract:Deitelzweig S, Lee D, Wharton F. Reducing Heart Failure Readmissions. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 18. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/reducing-heart-failure-readmissions/. Accessed May 26, 2019.