EDUCATE THE PATIENTS WITH HEART FAILURE TO REDUCE THE READMISSION RATE

Emiliy Moore, Calle Lindén, The Dinh Thi

Task

Key finding of QI summarized for the funder of your project

Background

20% among those 70-80 years in the western world have heart failure.

(Rosamond et al., 2008)

Heart failure is the most common reason for hospitalization in Sweden for people over the age of 65

(Swedish National Board of Health and Welfare (Socialstyrelsen), 2008).

Our typical patient we want to help Patient

65-85 years Heart failure, NYHA Class I-III Living at home or at a home for elderly

peoples Slightly decreased memory and

understanding Risk of going back to hospitalKnowled

ge Self-care

Reduced risk för

readmission

Why educate?

Reduced risk of readmission

More knowledge about their condition

Improved physical health

Better compliance to

self-care

Improved mental health and quality of

life

Quality issue

Reduce the readmission rate among patients with heart failure.

Measure the readmission rate

Educate and give the patient knowledge to better be able to perform self-care

• Improve the self-care through discharge education and telephone follow up along with web-based services

• Describe our measured results

• Quality issuses among patients with heart failure. What do we need to know about our patients and also which theories. How can we improve the situation

• Make a new PDSA cycle according to the data we receive from measurments

ACT PLAN

DOSTUDY

Intervention

Discharge

education

Telephone

follow up

Web-based

services

Leadership

1. LeadershipSetting and reaching collective goals, and to empower individuals autonomy and accountability• Ask -- raise the issue• Advise -- increase awareness of risk and benefits related to behaviour• Assist -- help the patient to identify a negotiated SMART (specific, measurable, achievable, realistic, timed) goal related to behaviour change and signpost if appropriate.

Measurments

Make two groups with the same kind of patients, one receiving the intervention one is not,

Count each time a patient in the study achieves one of the possibilities

Using statistical tools like the chi-square to see if the the outcome is significant

Effect Intervention g

Control g Reduction

(P-value and or CI)

Possiblity 1 x (n) y (n) % value

Possiblity 2

Possiblity 3

Possiblity 4

Possibilty 5

Example of measure

Patients who readmit to the ward n=100; 50 in each group

Effect Intervention group

Control group

Reduction

No readmission 20 10 50%

One or more readmission

10 20 -50%

Two or more readmission

10 10 -

Readmission but because of something else

5 5 -

Died 5 5 -

Ethical consideration

This is a very cost effective way to reduce the readmission rate among this group of patients

The education most be performed at a first class level to meet the demands of the global society needs.

Nurses educating the patients are required to have a deep understanding and exceptional knowledge about heart failure and self-care.

Education and readmission

Author, year Outcome 1 Outcome 2

Koelling, Johnson, Cody & Aaronson, 2005

Fewer days in hospital

Reduced risk of readmission

Krumholz, Amatruda, Smith, Mattera, Roumanis, Radford, Crombie & Vaccarino, 2002

Reduced risk of readmission

Fewer days in hospital

Kwok, Lee, Woo, Lee & Griffith, 2008

Reduced risk of readmission

Domingues, Clausell , Aliti, Dominguez & Rabelo, 2011

Reduced number of visits to the emergency room

What do we need to begin the project

Funding, 10000 euro before 15/5

Soon™, when it’s ready, contacts with healthcare leaders in the community

Access to databases

including but not limited to

patients journal and

work schedule

References

Albert, N., Collier, S., Sumodi, V., Wilkinson, S., Hammel J.,Vopat, L. et al. (2002). Nurses’ knowledge of heart failure education principles. Heart & Lung: The Journal of Acute and Critical Care, 31,(2), 102-112.

Hart, P., Spiva, L., Kimble, K. (2011). Nurses’ knowledge of heart failure education principles survey: a psychometric study, Journal of Clinical Nursing, 20, 3020–3028.

Lesman-Leegte, I., Jaarsma, T., Coyne, J., Hillege, H., Van Veldhuisen, D., Sanderman, R. (2008). Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community. Journal Of Cardiac Failure, 15(1), 17-23.

New York Heart Association Functional Classification, 2009 Rosamond, W., Flegal K., Furie K., Go, A., Greenlund K., Haase, N. et al. (2008).

Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117, 125–146.

Socialstyrelsen. (2008). Nationella Riktlinjer för hjärtsjukvård 2008. Stockholm: Socialdepartementet.

Strömberg, A. (2005). The crucial role of patient education in heart failure. The European Journal of Heart Failure, 7, 363–369