Preventable readmission for Heart Failure (HF) was estimated to be 27.1%. HF readmission may suggest inadequate treatment during a previous stay. For example, only 50% of patients have complete resolution of their congestive symptoms at hospital discharge. Fewer than 50% of the patients were discharged with at least 5‐6 lbs. weight loss. Twenty‐seven percent still had edema at discharge. The national average of HF readmission rate was 24.6%. Our HF readmission rate at our institution was as high as 25.5% in 2011.
We found that many of our patients were not clinically ready at the time of discharge according to Heart Failure Society of America (HFSA) Guidelines and clinical evidence. In response to the findings seen nationally and in our patient population we created a multidisciplinary HF Discharge Readiness Checklist (Figure 1) using the HFSA guidelines, as well as BNP level, code status discussion, and evidence‐based care transition.
In April 2012, we began utilizing the checklist on all patients with a primary diagnosis of HF. The RN HF coordinator and the RN case manager monitored the use of the checklist daily and provided feedback to the physicians and healthcare team to ensure compliance.
We compared the HF readmission rates before and after implementing the checklist by two methods. We used a statistical test of proportions with a confidence level of 95%. We compared the HF readmission rates for 18‐months prior to implementation of the checklist (Group One: 2253 patients) to those spanning 18‐months after (Group Two: 2626 patients). We also monitored our progress by comparing our observed readmission rate to the expected readmission rate (O/E ratio) as determined by Premier (Figure 2; Data Source: QualityAdvisor™ database maintained by Premier, Inc., Charlotte, NC).
Group One had a readmission rate of 19.1%. Group two had a readmission rate of 15.6%. This is a 3.5 percentage point reduction, which equates to an 18% improvement. The test of proportions comparing the two groups demonstrates a statistically significant difference between the readmission rates with a P‐Value = 0.001. Additionally, our 30‐day O/E readmit ratio 12‐month rolling average fell from roughly 1.2 to 0.8 as shown in Figure 2.
Use of a HF discharge readiness checklist is strongly associated with a reduction in HF readmission rates. It serves as a guide for better patient care coordination and to decrease unexplained practice variations. It has strong implications in terms of quality of care, morbidity, patient satisfaction, and cost reduction
To cite this abstract:Frederick S, Wai C, Edwards T, Olson M, Skike S, Hopfer P, Erlewine R, Boer M, Wiseman M, Mowreader D, Fall D, Ly H. Using a Discharge Readiness Checklist to Reduce Heart Failure Readmissions. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 122. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/using-a-discharge-readiness-checklist-to-reduce-heart-failure-readmissions/. Accessed May 23, 2019.