Implementation of an Evidence-based Discharge Checklist to Reduce 30-day Readmissions for Patients Diagnosed with Heart Failure

Transcription

1 Implementation of an Evidence-based Discharge Checklist to Reduce 30-day Readmissions for Patients Diagnosed with Heart Failure Susan R. Giscombe, DNP, APRN, FNP-c Diana Baptiste, DNP, RN 28 th Sigma Theta Tau International Research Congress July

2 Objectives By the end of this session, the learner will be able to: 1. Recognize three recommendations from the American Heart Association/ American College of Cardiology guidelines for discharging patients hospitalized with heart failure. 2. Identify two strategies for decreasing readmissions for patients hospitalized with heart failure. Conflict of Interest: The authors declare no conflict of interest. The authors received no financial support or commercial sponsorship for this study. 2

3 Background Globally, 23 million people are living with Heart Failure (HF) 5 million Americans with HF Annual costs: $34 billion Leading cause of hospital readmission About half of people who develop heart failure die within 5 years of diagnosis 3

4 Significance 193-bed Rural Community Hospital in Northeastern U.S Readmission rate between 22% 30% Up to 50% HF readmissions preventable 4

5 Search Strategy 5

6 Literature Review Use of a discharge checklist based on AHA/ACC recommendations can reduce 30-day readmissions. Providing evidence-based care is key to improving outcomes for patients w/ HF Providers are often interested in science-based discussions about quality improvement and value the implementation of evidence-based interventions. Hospital leaders can efficiently engage providers to promote use of EBP guidelines in practice 6

7 Purpose To implement an evidence-based discharge checklist and evaluate 30-day readmissions among patients hospitalized with heart failure 7

8 Aims Aim 1 Aim 2 Aim 3 Reduce 30-day readmission for individuals hospitalized with heart failure. Determine provider utilization of the discharge checklist Determine provider satisfaction with using the discharge checklist 8

9 Methods Design Quality improvement project, quantitative Sample Patients admitted for HF during September- November 2015 and September November 2016 Setting 165-bed, rural community hospital Exploratory Demographic data Measures Pre and post implementation readmission rates, Provider utilization and satisfaction responses Analyses Descriptive statistics, Independent t-test, Chi-Square 9

10 Methods Provider responses Group 1 Control 2015 Group 2 Intervention 2016 SPSS 10

11 Innovation 11

12 Innovation 12

13 Analyses Descriptive Statistics/Frequencies Independent Sample t-test Chi-Square- Fisher s Exact Test 13

14 Exploratory Data 14

15 Results: Aim #1 15

16 Result: Aim #2 16

17 Results: Aim #3 17

18 Discussion Readmissions among groups not statistically significant Slight decrease in admissions Providers responded positively to checklist Checklist can be used to reduce readmission 18

19 Discussion Limitations Results are not generalizable Single-site study Relatively small, non-randomized sample Provider use of checklist not mandatory Survey questions, reliability Self-reported data by providers More data needed 19

20 Conclusion Provider engagement is necessary for practice change Sustainability- Institutional and system-wide implementation Multidisciplinary discharge checklist integrated in HF order set in EHR Further study necessary to further validate effects of HF checklist 20

21 Leading the way in education, research and practice locally and globally.

22 References Al-Khazaali, A., Arora, R., Helu, H. K. (2014). Effective strategies in reducingrehospitalizations in patients with heart failure American Journal of Therapeutics Amarasingham, R., Patel, P. C., Toto, K., Nelson, L. L., Swanson, T. S., Moore, B. J.,... Halm, E. A. (2013). Allocating scarce resources in real-time to reduce heart failure readmissions: A prospective, controlled study. BMJ Quality & Safety, 22(12), doi: /bmjqs [doi] Balaban, R. B., Galbraith, A. A., Burns, M. E., Vialle-Valentin, C. E., Larochelle, M. R., & Ross-Degnan, D. (2015). A patient navigator intervention to reduce hospital readmissions among high-risk safety-net patients: A randomized controlled trial. Journal of General Internal Medicine, 30(7), doi: /s x [doi]doi: Barker, A., Barlis, P., Berlowitz, D., Page, K., Jackson, B., & Lim, W. K. (2012). Pharmacist directed home medication reviews in patients with chronic heart failure: A randomized clinical trial. International Journal of Cardiology, 159(2), doi: Basoor, A., Doshi, N.C., Cotant, J. F., Saleh, T., Todorov, M., Choksi, N., & Halabi, A. R Decreased rea dmissions and improved quality of care with the use of an inexpensive checklist in heart failure.congestive Heart Failure, 19(4), Blum, K., & Gottlieb, S. S. (2014). The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. Journal of Cardiac Failure, 20(7), doi: /j.cardfail [doi] Casteel, B Simple heart failure checklist reduces readmission rates, improves care, could save billions. American College of Cardiology s CardioSourece

23 References Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z., Sueta, C. A., Coker-Schwimmer, E.,.. Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis Transitional care for persons with heart failure. Annals Internal Medicine 160(11), doi: /m Fonarow, G. C. (2011). Improving quality of care and outcomes for heart failure. Circulation Journal, 75(8), Gheorghiade, M., Vaduganathan, M., Fonarow, G. C., & Bonow, R. O. (2013). Rehospitalization for heart failure: problems and perspectives. Journal of the American College of Cardiology, 61(4), Heidenreich, P. A., Trogdon, J. G., Khavjou, O. A., Butler, J., Dracup, K., Ezekowitz, M. D.,... & Lloyd-Jones, D. M. (2011). Forecasting the future of cardiovascular disease in the United States. Circulation, 123(8), Hong, Y., & LaBresh, K. A. (2006). Overview of the American Heart Association Get with the Guidelines programs: coronary heart disease, stroke, and heart failure. Critical pathways in cardiology, 5(4), Howie-Esquivel J., Carroll M., Brinker E., Kao H., Pantilat S., Rago K., & De, M. T. (2015). A strategy to reduce heart failure readmissions and inpatient costs. Cardiology Research 6(1),

24 References Jeffs, L., Dhalla, I., Cardoso, R., & Bell, C. M. (2014). The perspectives of patients, family members and healthcare professionals on readmissions: preventable or inevitable?. Journal of Interprofessional care, 28(6), Kociol, R. D., Peterson, E. D., Hammill, B. G., Flynn, K. E., Heidenreich, P. A., Piña, I. L.,... & Hernandez, A. F. (2012). National survey of hospital strategies to reduce heart failure readmissions: findings from the Get With the Guidelines-Heart Failure registry. Circulation: Heart Failure, CIRCHEARTFAILURE-112. McDade, R. (2015). Carroll hospital admissions spreadsheet. Unpublished manuscript. Ranasinghe, I., Wang, Y., Dharmarajan, K., Hsieh, A. F., Bernheim, S. M., & Krumholz, H. M. (2014). Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study. PLoS medicine, 11(9), e Turrise, S. (2014). Illness representations, treatment beliefs, medication adherence and hospital readmission in elderly individuals with chronic heart failure (Doctoral dissertation, Rutgers University-Graduate School-Newark). Wu, J. R., Lee, K. S., Dekker, R. D., Welsh, J. D., Song, E. K., Abshire, D. A.,... & Moser, D. K. (2016). Rehospital Delay, Precipitants of Admission, and Length of Stay in Patients With Exacerbation of Heart Failure. American Journal of Critical Care, 26(1), Zimmerman, L., Pozehl, B., Vuckovic, K., Barnason, S., Schulz, P., Seo, Y.,... & DeVon, H. A. (2016). Selecting symptom instruments for cardiovascular populations. Heart & Lung: The Journal of Acute and Critical Care, 45(6),