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
200
300
400
500
600
700
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
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