Reducing Readmissions of Patients with Heart Failure

In an article in the September issue of Nursing2010 Cheryl Burke,  director of quality at Mercy Hospital in Scranton, PA ,  ” …describes our hospital’s efforts to improve our care of patients with HF and reduce our readmission rates by focusing on patient discharge instructions.”

The Mercy Hospital heart failure performance improvement team used the PDCA cycle to develop a process that resulted a new HF patient education tool, as well as, a discharge sheet that included all elements required by CMS for discharge teaching.  

This HF PI process increased Mercy Hospital’s compliance with the six elements of CMS HF teaching from 30% in July 2006 to 100% in December 2008.

Burke CA.  Reducing readmissions of patients with heart failure.  Nursing 2010 Sep;40(9):12-13.

Lowering the Risk of Readmission for Heart Failure Patients

Decreasing the 30 day readmission rate for Medicare heart failure patients is  the target of both clinical research and quality improvement activities.   This observational analysis examined “…the association between outpatient follow-up within 7 days after discharge from a heart failure hospitalization and readmission within 30 days.”

Their findings support the hypothesis that “patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission.”   While recognizing the complexity of transitional care that  influences heart failure patient readmissions, this research provides an area for focusing efforts.

Hernandez AF, Greiner MA, Fonarow GC, Hammill BG, Heidenreich PA, Yancy CW,
Peterson ED, Curtis LH. Relationship between early physician follow-up and 30-day
readmission among Medicare beneficiaries hospitalized for heart failure. JAMA.
2010 May 5;303(17):1716-22. PubMed PMID: 20442387.

Reducing Avoidable Readmissions

The Commonwealth Fund published a guide “designed to serve as a starting point for hospital leaders to assess, prioritize, implement, and monitor strategies to reduce avoidable readmissions.”

Included are suggested strategies that the hospital can pursue at various stages of the care continuum to reduce avoidable readmissions.  Interestingly, one strategy, “use “teach-back” to educate patient/caregiver about diagnosis and care” appears in two sections.

Health Care Leader Action Guide to Reduce Avoidable Readmissions. Health Research & Educational Trust.  The Commonwealth Fund, and the John A. Hartford Foundation.  January 2010.

Improving Patient Discharge Process

The National Quality Forum Consensus Standards Maintenance committee identified hospital discharge as a critical area for improvement.

Brian Jack and his team at Boston Medical Center have  reengineered the hospital discharge process to decrease hospital utilization after discharge.  The clinical trial, which tested the effects of this program, found that “a package of discharge services reduced hospital utilization within 30 days of discharge.”

Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009 Feb 3;150(3):178-87. PubMed PMID:19189907.

Two articles that study the effectiveness of discharge nurses:

Maramba PJ, Richards S, Myers AL, Larrabee JH. Discharge planning process: applying a model for evidence-based practice. J Nurs Care Qual. 2004 Apr-Jun;19(2):123-9. Review. PubMed PMID: 15077829.

 
Lane BS, Jackson J, Odom SE, Cannella KA, Hinshaw L. Nurse satisfaction and creation of an admission, discharge, and teaching nurse position. J Nurs Care Qual. 2009 Apr-Jun;24(2):148-52. PubMed PMID: 19287254.