One of the leading causes of hospital admissions is cardiovascular disease. Innovations in technology and the advancement in science the aged population has increased and now has lent to more people being diagnosed with heart failure. As of 2013, it is reported that 5.1 million Americans are living with HF and this is one of the leading cause of hospitalizations across the country. Decompensation of HF will cause patients to seek treatment and often they are admitted into the hospital. And of those patients admitted approximately 25% of them will return within 30-days of discharge for worsening symptoms or an entirely different illness. It is reported HF readmissions may be preventable in up to 50% of the cases. Factors contributing to preventable readmissions include inconsistent in-patient care, physician errors, incorrect medication and/or dose titration and inadequate discharge planning. The cost for caring for HF patients is $34 billion annually and it is estimated that by 2030 to go as high as $70 billion dollars. Policy makers and payers have focused on this trend and are holding hospitals accountable for these readmissions.The American Heart Association/ American College of Cardiology guidelines provide specific recommendations for pharmacological and non-pharmacological therapies in the treatment of patients with heart failure. The purpose of this project was to implement an evidence-based clinical intervention to support clinicians in providing quality care is a safe and consistent manner, with a goal of decreasing the likelihood of patients with heart failure returning to the hospital within 30-days after discharge.
Our study was conducted at a 255-bed tertiary hospital in a rural region of the northeastern United States. We piloted a discharge checklist for two months, to be used by providers when discharging patients hospitalized for heart failure. This discharge checklist was developed based on recommendations from the American Heart Association/ American College of Cardiology that included prescribing medications from up to seven drug classifications such as diuretics, beta blockers, aldosterone antagonists, and nitrates. Recommended on-pharmacological therapies included patient education related to dietary and lifestyle modifications, as well as post-discharge follow-up. The checklist was added to electronic medical record. Physicians were educated regarding use the checklist when discharging all patients who were initially admitted for heart failure. We evaluated readmission rates for two groups of (N=96) patients who were discharged from the hospital in the pre and post intervention periods.
Prior to the intervention, readmission rates for the hospital were at 27% from the period of September 2015 to November, 2015. In the post intervention period, readmissions decreased to 17% from September 2016 to November, 2016.
A well-designed discharge plan remains a critical component of the patient discharge process, necessary to improve outcomes and reduce readmission. Consistent with previous studies, the implementation of evidence-based discharge checklists based on the American Heart Association/ American College of Cardiology recommendations can reduce the percentage of patients who are readmitted within 30 days of initial hospitalization. Nurses are uniquely qualified to promote use of checklists among providers in efforts to improve health outcomes. Further study is necessary to examine barriers to using discharge checklists by providers.
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