PREVENTING READMISSIONS OF

CONGESTIVE HEART FAILURE PATIENTS

Daidreanna Whiteman

Senior Project

Columbus State University

Summer 2014

Abstract

In the ever changing world of health care hospital readmissions has become a focus.

CMS is now reducing payments for patients with select diagnosis that are

readmitted within 30 days. CHF is one of these diagnosis. The focus now should be

placed on preventing hospital readmissions.

The Heart

(Emedicinehealth, 2014)

Congestive Heart Failure

•Approximately 5.1 Million people in America have Congestive Heart Failure (CHF) (Center for Disease Control and Prevention, 2013).

Congestive Heart Failure

•According to the Center for Disease Control (CDC) in 2009 heart failure was a contributing factor in one out of every 9 deaths (Center for Disease Control and Prevention, 2013).

Congestive Heart Failure

•Approximately one half of people diagnosed with CHF die within 5 years of being diagnosed (Center for Disease Control and Prevention, 2013).

Congestive Heart Failure

•CHF cost our nation about $32 billion a year related to medications, healthcare costs, and missed days of work (Center for Disease Control and Prevention, 2013).

Hospital Readmissions

•The Affordable Care Act 2010 has created a hospital readmission reduction program (CMS.gov, 2014),

What is readmission?

• Readmission is defined as an admission to a subsection hospital within 30 days of discharge from the same or another subsection hospital (CMS.gov, 2014).

(Office, 2014)

Congestive Heart Failure Readmission Rates

• Nationally almost 25% of CHF patients with Medicare are readmitted to the hospitals within 30 Days of discharge (Georgia Health News, 2013).

What are the reasons for readmission?

•Education•Psychosocial Issues

•Socioeconomic Issues(American Heart Association, 2014.)

How do we prevent readmission?

• Focus on care transitions after hospitalization• Involve ancillary departments in care during hospital as well as education

• Proper dietary education (American Heart Association, 2014).

How do we prevent readmission?

• Proper medication reconciliation• Arranging for follow-up visits before discharge• Having a process in place to send all discharge or electronic summaries directly to the patient’s primary care physician (American Heart Association, 2014).

How do we prevent readmission?

• Assigning staff to follow up with the patient regarding test results and medications after the patient is discharged.

• Proper education at discharge.• Involving physicians and groups in patient discharge (American Heart Association, 2014).

Evidence Based Study

• The American Heart Association conducted a study on CHF patients and readmission rates.

• 599 Hospitals participated in this study with post hospitalization surveys of patients with CHF (American Heart Association, 2014).

Evidence Based Study

•6 of the previously listed strategies were proven to significantly lower readmission rates (American Heart Association, 2014).

Evidence Based Study Results

• Partnering with community physicians or physician groups to reduce readmission was 33%.

• Having nurses responsible for medication reconciliation 18% lower.

• Arranging a follow-up appointment before discharge 19% decrease (American Heart Association, 2014).

Evidence Based Study Results

•Having a process in place to send all discharge paper or electronic summaries directly to the patient’s primary physician 21%.

•Follow up on test results that return after the patient is discharged 26% (American Heart Association, 2014).

What can nurses do?

•Nursing can start with education of the patient prior to discharge

•Ensure dietitian has met with patient prior to discharge

•Ensure proper medication reconciliation

What can nursing do?

•Ensure patients understands and are aware of follow up appointments and importance of follow up

•Ensure patients have a means to obtain medications

What can nursing do?

• Follow up with patient after discharge to ensure they are following discharge instructions, attending follow up appointments, and taking medications per instructions

• Ensure pharmacy speaks to patient regarding medications

• Ensure physicians are involved post discharge

QUESTIONS

(Office, 2014)

ReferencesAmerican Heart Association, 2014. Rehospitalization for Heart Failure: Predict or Prevent? Retrieved

from: http://circ.ahajournals.org/content/126/4/501.full

Center for Disease Control, 2013. Heart Failure Fact Sheet. Retrieved from:

http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

Center for Medicare & Medicaid Services, 2014. Readmission Reduction Program. Retrieved from:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html

Georgia Health News, 2013. Progress Being Made Against Costly Readmissions. Retrieved from:

http://www.georgiahealthnews.com/2013/12/progress-costly-readmissions/

References

Emedicinehealth, 2014. Slideshow Pictures: Heart Disease-Coronary Artery Disease/ Retrieved from:

http://www.emedicinehealth.com/slideshow_heart_disease/article_em.htm

Office, 2014. Hospital featuring an ambulance by an entrance. Retrieved from :

http://office.microsoft.com/en-

us/images/results.aspx?qu=hospitals&ex=1&origin=HA010237914#ai:MP900402701|