Strategies to Decrease CHF Readmissions

Beverly Jameson RN, MSN Nurse Manager Cardiac

TelemetryGreenville Memorial Medical Center

Introduction

• Heart Failure has reached epidemic proportions

• Heart Failure is expensive

• Frequent readmissions

Causes for Readmission (in order of frequency)

• Non-compliance with medication regimen, diet, and/or lifestyle

• Progression of underlying cardiac disease• Co-morbid conditions (obesity, diabetes,

hypertension, renal disease)

GMMC Strategy: Decrease Readmissions

• Cohort CHF patients to the Cardiac Telemetry Unit• Implement a system to review CHF Core Measure

compliance daily• Improve medication reconciliation using Core Measure

discharge planning standards• Improve patient education to decrease readmissions• Improve the timeliness of physician follow-up at

discharge• Involve Palliative Care earlier in the disease course• Solicit the buy-in of the CHF Team

Multidisciplinary Process Team Collaboration

• Oversight of the clinical course• All non-ICU CHF patients are assigned to 4C• Review the core measures on each CHF

patient daily• Medication Reconciliation (Pharmacy Pilot

Project)• Standing order for HeartLife and Case

Management

Multidisciplinary Process

• Weekly CHF Rounds• Monthly CHF Action Team• Discharge Nurse• Home Health Telemonitoring• Post-Acute Care Management

– Scales at discharge (GHS Auxiliary)– Staff Education at SNF

CHF Readmissions

• 3rd consecutive year rated “Better than National Average”

• Sustained decrease in CHF readmissions• All-Cause readmission rate of 19.7%

(national avg 24.8)• 8th lowest overall rate in the country • Readmission rate for CHF is 6.1%• All-Care Measure score is 98.08%

Data Analysis

Data Analysis

Data AnalysisSecondary Diagnosis

0

100

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800

Renal Disease Hypertension Diabetes Atrial Fib

20102012 annualized

Lessons Learned

• Staff buy-in is crucial (bedside nurses, Unit Council)

• Team approach is crucial – CHF management is multi-faceted

• Have opportunities to increase use of Palliative Care, provide discharge nurse 7 days/week, increase frequency of multidisciplinary CHF rounds, increase available technologies