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Item type Presentation

Format Text-based Document

Title Implementation of an Evidence-Based Practice Checklist toReduce 30-Day Readmission for Patients With HeartFailure

Authors Giscombe, Susan; Baptiste, Diana Lyn; Holley, MelissaJones

Downloaded 29-May-2018 21:55:37

Link to item http://hdl.handle.net/10755/622209

Implementation of an Evidence-based Discharge Checklist to Reduce 30-day Readmissions for

Patients Diagnosed with Heart Failure

Susan R. Giscombe, DNP, APRN, FNP-c

Diana Baptiste, DNP, RN

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28th Sigma Theta Tau International Research CongressJuly 2017

Objectives

By the end of this session, the learner will be able to:

1. Recognize three recommendations from the American Heart Association/ American College of Cardiology guidelines for discharging patients hospitalized with heart failure.

2. Identify two strategies for decreasing readmissions for patients hospitalized with heart failure.

Conflict of Interest: The authors declare no conflict of interest. The authors received no financial support or commercial sponsorship for this study.

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Background

• Globally, 23 million people are living with Heart Failure (HF)

• 5 million Americans with HF

• Annual costs: $34 billion

• Leading cause of hospital readmission

• About half of people who develop heart failure die within 5 years of diagnosis

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Significance

193-bed Rural Community Hospital in Northeastern U.S

• Readmission rate between 22% – 30%

• Up to 50% HF readmissions preventable

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Search Strategy

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Literature Review

•Use of a discharge checklist based on AHA/ACC recommendations can reduce 30-day readmissions.

•Providing evidence-based care is key to improving outcomes for patients w/ HF

•Providers are often interested in science-based discussions about quality improvement and value the implementation of evidence-based interventions.

•Hospital leaders can efficiently engage providers to promote use of EBP guidelines in practice

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Purpose

To implement an evidence-based discharge checklist and evaluate 30-day

readmissions among patients hospitalized with heart failure

Aim 1• Reduce 30-day readmission for individuals

hospitalized with heart failure.

Aim 2• Determine provider utilization of the

discharge checklist

Aim 3

• Determine provider satisfaction with using the discharge checklist

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Aims

Methods

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Quality improvement project, quantitative

Patients admitted for HF during September-November 2015 and September – November 2016

165-bed, rural community hospital

Demographic data

Pre and post implementation readmission rates, Provider utilization and satisfaction responses

Descriptive statistics, Independent t-test, Chi-Square

Design

Sample

Setting

Exploratory

Measures

Analyses

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Methods

SPSS

Group 1 Control

2015

Provider responses

Group 2 Intervention

2016

Innovation

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Innovation

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Analyses

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Descriptive Statistics/Frequencies

Independent Sample t-test

Chi-Square- Fisher’s Exact Test

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Exploratory Data

Results: Aim #1

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Result: Aim #2

Results: Aim #3

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Discussion

• Readmissions among groups not statistically significant

• Slight decrease in admissions

• Providers responded positively to checklist

• Checklist can be used to reduce readmission

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Discussion

Limitations

• Results are not generalizable

• Single-site study

• Relatively small, non-randomized sample

• Provider use of checklist not mandatory

• Survey questions, reliability

• Self-reported data by providers

• More data needed

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• Provider engagement is necessary for practice change

• Sustainability- Institutional and system-wide implementation

• Multidisciplinary discharge checklist integrated in HF order set in EHR

• Further study necessary to further validate effects of HF checklist

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Conclusion

Leading the way in education, research and practice – locally and globally.

• Al-Khazaali, A., Arora, R., Helu, H. K. (2014). Effective strategies in reducingrehospitalizations in patients with heart failure 2014.American Journal of Therapeutics

• Amarasingham, R., Patel, P. C., Toto, K., Nelson, L. L., Swanson, T. S., Moore, B. J., . . . Halm, E. A. (2013). Allocating scarce resources in real-time to reduce heart failure readmissions: A prospective, controlled study. BMJ Quality & Safety, 22(12), 998-1005. doi:10.1136/bmjqs 2013-001901 [doi]

• Balaban, R. B., Galbraith, A. A., Burns, M. E., Vialle-Valentin, C. E., Larochelle, M. R., & Ross-Degnan, D. (2015). A patient navigator intervention to reduce hospital readmissions among high-risk safety-net patients: A randomized controlled trial. Journal of General Internal Medicine, 30(7), 907-915. doi:10.1007/s11606-015-3185-x [doi]doi:http://dx.doi.org.proxy1.library.jhu.edu/10.1016/j.ijcard.2011.02.034

• Barker, A., Barlis, P., Berlowitz, D., Page, K., Jackson, B., & Lim, W. K. (2012). Pharmacist directed home medication reviews in patients with chronic heart failure: A randomized clinical trial. International Journal of Cardiology, 159(2), 139-143. doi:http://dx.doi.org.proxy1.library.jhu.edu/10.1016/j.ijcard.2011.02.034

• Basoor, A., Doshi, N.C., Cotant, J. F., Saleh, T., Todorov, M., Choksi, N., & Halabi, A. R. 2013. Decreased rea

• dmissions and improved quality of care with the use of an inexpensive checklist in heart failure.Congestive Heart Failure, 19(4), 200-206

• .

• Blum, K., & Gottlieb, S. S. (2014). The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. Journal of Cardiac Failure, 20(7), 513-521. doi:10.1016/j.cardfail.2014.04.016 [doi]

• Casteel, B. 2012. Simple heart failure checklist reduces readmission rates, improves care, could save billions. American College of Cardiology’s CardioSourece. 19-20

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References

References

• Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z., Sueta, C. A., Coker-Schwimmer, E., . . Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis Transitional care for persons with heart failure. Annals Internal Medicine 160(11), 774-784. doi:10.7326/M14-0083

• Fonarow, G. C. (2011). Improving quality of care and outcomes for heart failure. Circulation Journal, 75(8), 1783-1790.

• Gheorghiade, M., Vaduganathan, M., Fonarow, G. C., & Bonow, R. O. (2013). Rehospitalization for heart failure: problems and perspectives. Journal of the American College of Cardiology, 61(4), 391-403.

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• Howie-Esquivel J., Carroll M., Brinker E., Kao H., Pantilat S., Rago K., & De, M. T. (2015). A strategy to reduce heart failure readmissions and inpatient costs. Cardiology Research 6(1), 201-208.

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References

• Jeffs, L., Dhalla, I., Cardoso, R., & Bell, C. M. (2014). The perspectives of patients, family members and healthcare professionals on readmissions: preventable or inevitable?. Journal of Interprofessional care, 28(6), 507-512.

• Kociol, R. D., Peterson, E. D., Hammill, B. G., Flynn, K. E., Heidenreich, P. A., Piña, I. L., ... & Hernandez, A. F. (2012). National survey of hospital strategies to reduce heart failure readmissions: findings from the Get With the Guidelines-Heart Failure registry. Circulation: Heart Failure, CIRCHEARTFAILURE-112.

• McDade, R. (2015). Carroll hospital admissions spreadsheet. Unpublished

manuscript.

• Ranasinghe, I., Wang, Y., Dharmarajan, K., Hsieh, A. F., Bernheim, S. M., & Krumholz, H. M. (2014). Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study. PLoS medicine, 11(9), e1001737

• Turrise, S. (2014). Illness representations, treatment beliefs, medication adherence and hospital readmission in elderly individuals with chronic heart failure (Doctoral dissertation, Rutgers University-Graduate School-Newark).

• Wu, J. R., Lee, K. S., Dekker, R. D., Welsh, J. D., Song, E. K., Abshire, D. A., ... & Moser, D. K. (2016). Rehospital Delay, Precipitants of Admission, and Length of Stay in Patients With Exacerbation of Heart Failure. American Journal of Critical Care, 26(1), 62-69.

• Zimmerman, L., Pozehl, B., Vuckovic, K., Barnason, S., Schulz, P., Seo, Y., ... & DeVon, H. A. (2016). Selecting symptom instruments for cardiovascular populations. Heart & Lung: The Journal of Acute and Critical Care, 45(6), 475-496.

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