A Spoonful of Heart Failure Resources Helps the Medicine Units Readmission Rates Go Down

Background

Heart failure is the leading cause of hospitalization in the United States and is associated with increased mortality, imposed stress on patients, and financial/capacity burdens on health care systems (AHA, 2022).

Medicine units were experiencing 30-day heart failure readmission rates above the hospital benchmark of 15.8%. Medicine units had higher rates of readmissions than the cardiac units for the heart failure population. A gap analysis found these units were lacking evidence-based strategies for patients admitted with heart failure.

Purpose

The performance improvement project aimed to evaluate effectiveness of specific interventions designed to reduce heart failure 30-day readmission rates on non-cardiac medicine units. The goal was to reduce readmissions in these areas through implementing the Heart Failure Bundle; a series of targeted strategies that includes patient education, scheduling follow up appointments within 7-10 days prior to discharge, providing scales and post discharge callbacks.

Setting/Population

The medicine units in a large, urban academic medical center in Chicago, Illinois. The population included adults with heart failure admitted inpatient or observation regardless of diagnosis.

Method/Process

The heart failure team met with the medicine nursing and physician leadership division to share readmission data and analyze root causes for heart failure re-admissions. A full-time heart failure nurse navigator was dedicated to the medicine units to assist in implementation of the bundle. The navigator met with each unit, identified unit specific needs, attended interdisciplinary rounds and quality meetings, and educated staff members. The navigator began meeting with patients to provide comprehensive heart failure education and issue home scales, escalating care to specialized Cardiology services when indicated, and coordinating transitions of care.

Outcome Measures

The hospital's benchmark for heart failure readmissions is 15.8%. All cause, unplanned 30-day heart failure readmissions were measured pre and post intervention. On the pilot unit, heart failure readmissions were reduced from a pre-intervention 6-month average of 21.2% to a post intervention 6-month average of 10.6%.

The pre-intervention 6-month average of the remaining units was 21.46%. Five months post intervention, the remaining units showed a decrease in average readmission rate to 12.3%.

Practical Implications

The team identified that heart failure readmissions occurring in non-cardiac areas were not meeting benchmark and having an overall impact on the hospital's readmission rate.

Designating a heart failure navigator to execute the evidence-based bundle that proved successful on cardiac units could also be implemented on medicine units. Allocating described resources to these non-cardiac units and identifying process gaps helped the team focus interventions and address the needs of heart failure patients regardless of location throughout the hospital.

Identifying variations in heart failure management for inpatients and allocating resources to non-cardiac areas allowed the team to focus efforts in a targeted and meaningful way. These efforts have shown to improve 30-day readmissions and positively impact the heart failure population.