A HEART CARE NAVIGATION TEAM IMPROVES ACUTE MYOCARDIAL .../media/Non-Clinical/Files-PDFs... · A...
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A HEART CARE NAVIGATION TEAM IMPROVES ACUTE MYOCARDIAL INFARCTION CARE AND OUTCOMES BACKGROUND William Downey, MD, FACC, FSCAI | Stephen Wright, MBA, RN | Ciearra Heidelberg, MPH Shanie Ramirez, RN, MSN, CNML, CVRN-BC | Tom Draper, MBA | Amber Furr, BSN, RN, CPHQ In 2017, a Heart Care Navigation Team was implemented to optimize acute myocardial infarction (AMI) care transitions in order to improve compliance with guideline-based care, reduce mortality and minimize avoidable readmissions. One health advocate and two full-time AMI nurse navigators were hired in the summer of 2017. Using the Plan, Do, Study, Act methodology, the team’s workflow evolved to (1) enhance the discharging process with- out adding additional burden to the exist- ing clinical staff, and (2) provide AMI patients with direct access to a clinical resource during and after the hospital stay. During the inpatient encounter, the nurse navigator focuses on education, care co- ordination, and quality improvement. The team assists with timely access to follow- up care, promotes self-management, and addresses patients’ questions or concerns for a period of 90 days following hospital discharge. During this 90-day post dis- charge period the duration of care can reset if the patient has an additional inpa- tient encounter. This program is limited to weekdays during business hours. METHODS RESULTS Patients appropriate for heart care navigation were iden- tified based on the criterion: principle diagnosis of AMI. During Aug17–July18 approximately 680 patients were found to be appropriate for navigation care. Comparing pre- to post- Heart Care Navigation Team implementa- tion (i.e., July16–June17 vs. Aug17–July18), our internal data showed a reduction in AMI 30-day same-facility re- admissions observed/expected ratios (0.58 vs 0.42) and well below the Premier Top Decile [0.69], a reduction in AMI 30-day observed mortality rate (5.75% vs. 4.57%), and an increase in AMI patients’ follow-up appointments made prior to hospital discharge (78% vs 96%). Data from the Chest Pain—MI Registry showed an increase in overall defect free care (83.3% vs 85.1%) and an increase in cardiac rehab referrals (85.7% vs 88.6%). CONCLUSIONS Results indicate successful impact of the Heart Care Navigation Team at the System’s quaternary facility. There remains opportunity to improve defect free care, particularly referral to cardiac rehabilitation. Similar pro- grams were implemented at two additional tertiary care facilities within the System, both of which have yielded similarly positive results. Strengths of the program in- clude a one-on-one relationship between patient and Heart Care Navigator team through the care transitions and a strong collaborative relationship between the team and providers. CLINICAL IMPLICATION A well-designed Heart Care Navigation team appears to improve guideline-based care and patient outcomes. Baseline Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 30-Day Observed Mortality Rate 30-Day AMI Observed Mortaltiy Rate (rolling year) Target (5.25) All Hospitals 75th% All Hospitals 90th% % Overall Defect Free Care All Hospitals 50th% Q2 2017 Pre Nurse Navigator Q2 2018 Post Nurse Navigator 6.5 6.0 5.5 5.0 4.5 4.0 F A V O R A B L E Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Follow-up Appointments Made Prior to Discharge AMI Patients’ Follow-up Appointments Made Prior to Discharge Target (80%) Chest Pain-MI Registry Overall Defect Free Care Lead Investigator: Dr. William Downey | No faculty disclosures Chest Pain-MI Registry Inpatient Cardiac Rehab Referral 100% 90% 80% 70% 60% 50% F A V O R A B L E Baseline Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 AMI 30-Day Same-Facility Readmissions O/E Nurse Navigator Workflow Navigator Patient Coverage Timeline AMI 30-Day Same-Facility Readmissions O/E (rolling year) Target (0.69 Premier Top Decile) 0.75 0.70 0.65 0.60 0.55 0.50 0.45 0.40 0.35 0.30 F A V O R A B L E 100 90 80 70 83.3 81.9 90.6 95.9 85.1 96.8 All Hospitals 75th% All Hospitals 90th% % Cardiac Rehab Referral All Hospitals 50th% Q2 2017 Pre Nurse Navigator Q2 2018 Post Nurse Navigator 100 90 80 70 85.7 88.6 Identify Patients Patient Rounding Address Needs & Concerns Post Discharge Contact Create Daily Worklist & Task Poster design and printing by Blazon Productions, LLC 89.3 100.0 If Readmitted, ED Visit, Obs 90 Days After Hospital Discharge Hospital Admission (Day One)
Transcript of A HEART CARE NAVIGATION TEAM IMPROVES ACUTE MYOCARDIAL .../media/Non-Clinical/Files-PDFs... · A...
A HEART CARE NAVIGATION TEAM IMPROVES ACUTEMYOCARDIAL INFARCTION CARE AND OUTCOMES
BACKGROUND
William Downey, MD, FACC, FSCAI | Stephen Wright, MBA, RN | Ciearra Heidelberg, MPHShanie Ramirez, RN, MSN, CNML, CVRN-BC | Tom Draper, MBA | Amber Furr, BSN, RN, CPHQ
In 2017, a Heart Care Navigation Team was implemented to optimize acute myocardial infarction (AMI) care transitions in order to improve compliance with guideline-based care, reduce mortality and minimize avoidable readmissions.
One health advocate and two full-time AMI nurse navigators were hired in the summer of 2017. Using the Plan, Do, Study, Act methodology, the team’s work�ow evolved to
(1) enhance the discharging process with-out adding additional burden to the exist-ing clinical staff, and
(2) provide AMI patients with direct access to a clinical resource during and after the hospital stay.
During the inpatient encounter, the nurse navigator focuses on education, care co-ordination, and quality improvement. The team assists with timely access to follow-up care, promotes self-management, and addresses patients’ questions or concerns for a period of 90 days following hospital discharge. During this 90-day post dis-charge period the duration of care can reset if the patient has an additional inpa-tient encounter. This program is limited to weekdays during business hours.
METHODS
RESULTSPatients appropriate for heart care navigation were iden-ti�ed based on the criterion: principle diagnosis of AMI. During Aug17–July18 approximately 680 patients were found to be appropriate for navigation care. Comparing pre- to post- Heart Care Navigation Team implementa-tion (i.e., July16–June17 vs. Aug17–July18), our internal data showed a reduction in AMI 30-day same-facility re-admissions observed/expected ratios (0.58 vs 0.42) and well below the Premier Top Decile [0.69], a reduction in AMI 30-day observed mortality rate (5.75% vs. 4.57%), and an increase in AMI patients’ follow-up appointments made prior to hospital discharge (78% vs 96%). Data from the Chest Pain—MI Registry showed an increase in overall defect free care (83.3% vs 85.1%) and an increase in cardiac rehab referrals (85.7% vs 88.6%).
CONCLUSIONSResults indicate successful impact of the Heart Care Navigation Team at the System’s quaternary facility. There remains opportunity to improve defect free care, particularly referral to cardiac rehabilitation. Similar pro-grams were implemented at two additional tertiary care facilities within the System, both of which have yielded similarly positive results. Strengths of the program in-clude a one-on-one relationship between patient and Heart Care Navigator team through the care transitions and a strong collaborative relationship between the team and providers.
CLINICAL IMPLICATIONA well-designed Heart Care Navigation team appears to improve guideline-based care and patient outcomes.
BaselineSep-17
Oct-17Nov-17
Dec-17Jan-18
Feb-18Mar-18
Apr-18May-18
Jun-18Jul-18
Aug-18Sep-18
Oct-18
30-Day Observed Mortality Rate
30-Day AMI Observed Mortaltiy Rate (rolling year) Target (5.25)
All Hospitals 75th%All Hospitals 90th%% Overall Defect Free Care All Hospitals 50th%
Q2 2017Pre Nurse Navigator
Q2 2018Post Nurse Navigator
6.5
6.0
5.5
5.0
4.5
4.0
FAVORABLE
Sep-17Oct-17
Nov-17Dec-17
Jan-18Feb-18
Mar-18Apr-18
May-18Jun-18
Jul-18Aug-18
Sep-18Oct-18
Follow-up Appointments Made Prior to Discharge
AMI Patients’ Follow-up Appointments Made Prior to Discharge Target (80%)
Chest Pain-MI Registry Overall Defect Free Care
Lead Investigator: Dr. William Downey | No faculty disclosures
Chest Pain-MI Registry Inpatient Cardiac Rehab Referral
100%
90%
80%
70%
60%
50%
FAVORABLE
BaselineSep-17
Oct-17Nov-17
Dec-17Jan-18
Feb-18Mar-18
Apr-18May-18
Jun-18Jul-18
Aug-18Sep-18
Oct-18
AMI 30-Day Same-Facility Readmissions O/E Nurse Navigator Work�ow
Navigator Patient Coverage Timeline
AMI 30-Day Same-Facility Readmissions O/E (rolling year) Target (0.69 Premier Top Decile)
0.75
0.70
0.65
0.60
0.55
0.50
0.45
0.40
0.35
0.30
FAVORABLE
100
90
80
70
83.381.9
90.6
95.9
85.1
96.8
All Hospitals 75th%All Hospitals 90th%% Cardiac Rehab Referral All Hospitals 50th%
Q2 2017Pre Nurse Navigator
Q2 2018Post Nurse Navigator
100
90
80
70
85.788.6
IdentifyPatients
PatientRounding
AddressNeeds &Concerns
PostDischargeContact
CreateDaily
Worklist& Task
Poster design and printing by Blazon Productions, LLC
89.3
100.0
If Readmitted,ED Visit, Obs
90 Days AfterHospital Discharge
Hospital Admission(Day One)
