Cargando…

Putting veterans with heart failure FIRST improves follow-up and reduces readmissions

BACKGROUND: Despite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissi...

Descripción completa

Detalles Bibliográficos
Autores principales: Ogunwole, Serena Michelle, Phillips, Jason, Gossett, Amber, Downs, John Richard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340603/
https://www.ncbi.nlm.nih.gov/pubmed/30729191
http://dx.doi.org/10.1136/bmjoq-2018-000386
_version_ 1783388813496680448
author Ogunwole, Serena Michelle
Phillips, Jason
Gossett, Amber
Downs, John Richard
author_facet Ogunwole, Serena Michelle
Phillips, Jason
Gossett, Amber
Downs, John Richard
author_sort Ogunwole, Serena Michelle
collection PubMed
description BACKGROUND: Despite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissions, implementation strategies are challenging in resource-limited settings. Here we present a quality improvement initiative aimed at improving early follow-up while maximising available resources. METHODS: This was a medical resident-driven initiative. A process map of the discharge and follow-up appointment process was created that identified multiple areas for improvement. Based on these findings, a two-part intervention was implemented. First, heart failure discharge education with focus on early follow-up was disseminated to providers throughout the internal medicine department. Subsequently, improved identification of high-risk patients (Failure Intervention Risk StratificationTool) and innovative use of the existing electronic medical record (EMR) were employed to sustain and improve on gains from the first set of interventions. RESULTS: We increased our 7-day follow-up rate from 47% to 57% (p=0.429) and decreased the average time to follow-up from 17.6 days to 8.7 days (p=0.016) following the first intervention. The percentage of patients readmitted within 30 days after discharge at baseline (2012–2013) and following the first intervention (education and standardisation of follow-up scheduling) and second intervention (risk stratification, intensive follow-up and EMR change) was 25% and 21%, respectively. Thirty-day mortality rate decreased from 10% in 2011 to 7.16% in December 2015. CONCLUSION: Close hospital discharge follow-up and identification of high-risk patients with CHF are useful approaches to reduce readmissions. Using the existing EMR tool for identifying high-risk patients and improving adherence to best practices is an effective intervention. In patients with CHF these strategies improved time to follow-up and 30-day readmissions while decreasing mortality.
format Online
Article
Text
id pubmed-6340603
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-63406032019-02-06 Putting veterans with heart failure FIRST improves follow-up and reduces readmissions Ogunwole, Serena Michelle Phillips, Jason Gossett, Amber Downs, John Richard BMJ Open Qual BMJ Quality Improvement report BACKGROUND: Despite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissions, implementation strategies are challenging in resource-limited settings. Here we present a quality improvement initiative aimed at improving early follow-up while maximising available resources. METHODS: This was a medical resident-driven initiative. A process map of the discharge and follow-up appointment process was created that identified multiple areas for improvement. Based on these findings, a two-part intervention was implemented. First, heart failure discharge education with focus on early follow-up was disseminated to providers throughout the internal medicine department. Subsequently, improved identification of high-risk patients (Failure Intervention Risk StratificationTool) and innovative use of the existing electronic medical record (EMR) were employed to sustain and improve on gains from the first set of interventions. RESULTS: We increased our 7-day follow-up rate from 47% to 57% (p=0.429) and decreased the average time to follow-up from 17.6 days to 8.7 days (p=0.016) following the first intervention. The percentage of patients readmitted within 30 days after discharge at baseline (2012–2013) and following the first intervention (education and standardisation of follow-up scheduling) and second intervention (risk stratification, intensive follow-up and EMR change) was 25% and 21%, respectively. Thirty-day mortality rate decreased from 10% in 2011 to 7.16% in December 2015. CONCLUSION: Close hospital discharge follow-up and identification of high-risk patients with CHF are useful approaches to reduce readmissions. Using the existing EMR tool for identifying high-risk patients and improving adherence to best practices is an effective intervention. In patients with CHF these strategies improved time to follow-up and 30-day readmissions while decreasing mortality. BMJ Publishing Group 2019-01-14 /pmc/articles/PMC6340603/ /pubmed/30729191 http://dx.doi.org/10.1136/bmjoq-2018-000386 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle BMJ Quality Improvement report
Ogunwole, Serena Michelle
Phillips, Jason
Gossett, Amber
Downs, John Richard
Putting veterans with heart failure FIRST improves follow-up and reduces readmissions
title Putting veterans with heart failure FIRST improves follow-up and reduces readmissions
title_full Putting veterans with heart failure FIRST improves follow-up and reduces readmissions
title_fullStr Putting veterans with heart failure FIRST improves follow-up and reduces readmissions
title_full_unstemmed Putting veterans with heart failure FIRST improves follow-up and reduces readmissions
title_short Putting veterans with heart failure FIRST improves follow-up and reduces readmissions
title_sort putting veterans with heart failure first improves follow-up and reduces readmissions
topic BMJ Quality Improvement report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340603/
https://www.ncbi.nlm.nih.gov/pubmed/30729191
http://dx.doi.org/10.1136/bmjoq-2018-000386
work_keys_str_mv AT ogunwoleserenamichelle puttingveteranswithheartfailurefirstimprovesfollowupandreducesreadmissions
AT phillipsjason puttingveteranswithheartfailurefirstimprovesfollowupandreducesreadmissions
AT gossettamber puttingveteranswithheartfailurefirstimprovesfollowupandreducesreadmissions
AT downsjohnrichard puttingveteranswithheartfailurefirstimprovesfollowupandreducesreadmissions