Reducing Heart Failure Hospital Readmissions: Are You Prepared?
Reducing 28 day Readmission for Heart Failure Patients.
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Transcript of Reducing 28 day Readmission for Heart Failure Patients.
Reducing 28 Day Readmission for Heart
Failure Patients BC Patient Safety Quality Council
Quality ForumFebruary 19, 2015
Suzanne Nixon MSN RN CCN(C)
Clinical Nurse SpecialistRegional Heart Failure Strategy
Summary
Background/ Context
Issue/ Problem
Strategy/ Intervention
Measurements
Ongoing challenges
Context: Burden of Heart Failure
• It is estimated that there are 500,000 Canadians living with heart failure and 50,000 new patients are diagnosed each year (Ross et al, 2006).
• Depending on the severity of symptoms, heart dysfunction, age and other factors, heart failure can be associated with an annual mortality of between 5% and 50% (Canadian Cardiovascular Society [CCS], 2006).
• Up to 40% to 50% of people with congestive heart failure die within five years of diagnosis (CCS, 2001).
Source: Heart and Stroke Foundation 2015
Population Pyramid
5
Heart Failure in BC
0
20000
40000
60000
80000
100000
120000
2001
/02
2002
/03
2003
/04
2004
/05
2005
/06
2006
/07
2007
/08
2008
/09
2009
/10
2010
/11
Incidence
Prevalence
Mortality
BC Ministry of Health, Medical Services and Health Human Resources Division, 2012
Heart Failure Costs in BC
BC Ministry of Health, Medical Services and Health Human Resources Division, 2012
The “Picture” of Heart Failure
Provincial Strategy
BC’s Heart Failure Network
• Established in early 2010
• Collaboration between Cardiac Service BC and 5 Health Authorities
• Funded by CSBC
Address the burden of HF By:
• Creating standardized HF resources
• Improving access to evidence based HF resources
• Standardizing HF care across the province
• Facilitate patients’ HF self-management
• Improving access diagnostics and HF specialist care
• Facilitating shared care across the health care continuum
Problem/Issue
2014 Report on the Health of Canadians
“Heart and Stroke Foundation’s report shows more people are surviving heart attacks and strokes, but they face challenges and lack support to thrive to the fullest”
Source: Heart and Stroke Foundation, February 2014
Problems/Issues
• Patients discharged unprepared and often unsupported
• Patients unable to self-manage - overload
• Get into trouble – come back to emergency
• 28-day readmission rates over target
Strategy/Intervention
Quality Improvement Project
Where: Cardiac Units at SPH
When: May 2014 to January 2015
What: Introduce and evolve educational tools
How: repeated PDSA cycles
Why: improve self management
Goal: to reduce 28 day re-admission rates
QA Tools
PDSA
PDSA
PDSA Cycles
• #1Information gathering
• #2 Introducing QI Project
• #3 Check–In
• #4 Monitor over time
Intervention Tools
Measurements
• Pre survey
• Post survey
• Tracking use of education tool
Heart Failure Pre-test Teaching Survey
Heart Failure Video.wmv
Heart Failure Pre and Post Teaching Survey
Heart Failure Teaching - Post Survey
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5 6
Reasons Given
Per
cen
tag
e
Series1
Tracking Use
Uptake of Teaching Tool
01020304050
9/16
/201
4
9/30
/201
4
10/1
4/20
14
10/2
8/20
14
11/1
1/20
14
11/2
5/20
14
12/9
/201
4
12/2
3/20
14
1/6/
2015
1/20
/201
5
Date
# o
f T
oo
ls u
sed
5A
5B
Median
Average
Ongoing Challenges
• Lack of time to spend with patient on education
• systems issues
• Complex co-morbidities and frail elderly
• Lack of coordinated sustained community support and follow-up