Decreasing All Cause Readmissions for Heart Failure - What Does it Take?

Purpose:
The project's purpose was to reduce thirty day readmissions and improve quality of care in patients with heart failure. The project started in October 2009, with the aim to reduce the number of all-cause rehospitalizations for heart failure by twenty percent by April 2011.

Significance:
The unit this project occurred on is one of two cardiac telemetry units in the hospital, accounting for twenty one percent of the heart failure population for the hospital. The all-cause readmission rate for the unit at the start of the project was greater than twenty five percent.

Strategy and Implementation:
A multidisciplinary team, led by the clinical nurse specialist, used the small test of change process, to initiate and evaluate changes. The changes resulted in a "process bundle", which included: 1. identifying and flagging patients within twenty four hours of admission as high-risk for readmission 2. consistently identifying the learner and plan of care champion (PoCC) on admission 3. customizing the education process for the patient and PoCC, with continuity on discharge 4. using "teach back" to validate the education provided 5. pharmacy consult while hospitalized to assist with medication reconciliation and education 6. homecare referral with a diuretic protocol for all heart falure patients 7. scheduling a follow up visit within three to five days of discharge with the patient's primary care physician.

Evaluation:
Results at the end of one year showed the process bundle reduced the heart failure patient all-cause readmission rate by twenty eight percent, and the all patient for all-cause readmission rate by eighteen percent. Compliance with the process measures ranged from sixty-four to one hundred percent.

Implications for Practice:
The heart failure patient has many comorbidities that impact readmission. A multidisciplinary team of stakeholders including the patient, family, in-hospital and out-hospital providers is required for designing and implementing effective interventions that will have a positive effect on outcomes.