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Impact of a Nursing Navigator Program on Heart Failure Readmissions at Two
Community Teaching Hospitals Matthew Bledsoe, PharmD, BCPS, Terry Eads, MBA, CHSP, CPHRM , Amber Murdock, MBA, CPHQ
Heart Failure Navigators: Rachel Garrard, RN, Christina Goodman, RN, Kelly Reed, RN
Disclosures
• The authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities: No authors have any disclosures.
Introduction
Approximately one in every five patients admitted with heart failure return to the hospital within 30 days of discharge.1
The national average 30-day readmission rate for heart failure is 21.9%.1
The Centers for Medicare and Medicaid Services (CMS) began the Hospital Readmissions Reduction Program (HRRP) in 2012 with the goal of improving patient care.2
1. Readmissions and Deaths: National. Centers for Medicare and Medicaid Services. Published December 18, 2016. https://data.medicare.gov/Hospital-Compare/Readmissions-and-Deaths-National/qqw3-t4ie
2. Readmissions Reduction Program (HRRP). Centers for Medicare and Medicaid Services. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html
Introduction
Increased utilization adds strain to the healthcare system and increases costs incurred by patients.
Heart failure costs the nation an estimated $30.7 billion each year. This total includes the cost of healthcare services, medications to treat heart failure, and missed days of work.3
Circulation. 2011;123(8):933-44.
Background
Bristol Regional Medical Center and Holston Valley Medical Center are two community teaching hospitals within Wellmont Health System that were experiencing a high heart failure readmission rate.
Both hospitals service populations in Northeast Tennessee and Southwest Virginia.
The readmissions committees at Wellmont Health System determined the reasons for an increased heart failure readmission rate were multifactorial.
Background
The committees identified focus areas which included the need for improving education and providing better follow-up post discharge.
The Re-engineered Discharge Project (Project RED) utilized discharge and education services conducted by a nurse discharge advocate; which resulted in a statistically significant reduction in emergency department (ED) and hospital utilization within 30 days.4
The committees decided to utilize the concept introduced by Project RED and initiated a heart failure nursing navigator program.
Ann Intern Med. 2009; 150(3):178-87.
Objective
Determine the impact of a heart failure nursing navigator program on heart failure readmission rates
Methods
Multicenter, nonrandomized retrospective, observational study
IRB approved Timeframe: November 2014- December 2016
Inclusion/Exclusion Criteria
Inclusion Criteria: Inpatients > 18 years of age Diagnosis of congestive heart failure, diastolic heart
dysfunction, cardiomyopathy, decreased ejection fraction, or a history of congestive heart failure with no prior education documented
Exclusion Criteria:
Pregnancy Patients enrolled in the Cardiovascular Associates Heart Failure
Clinic Patients discharged to locations other than home
Heart Failure Navigator Process
Initial Visit
Utilizes teach-back method to determine comprehension Provides additional education Assesses barriers to discharge
Discharge Education
Ensures follow-up appointment is made within seven days of hospital discharge Ensures the patient is discharged on appropriate therapy Reviews discharge instructions and medication instructions
Follow-Up Phone
Calls
The purpose is to check on the patient to see how they are doing post discharge and to determine if the patient has any questions related to their treatment
Day 2, Day 7, Day 16, and Day 23
Meets with patient/caregiver to explain navigator program Provides initial comprehensive heart failure education
Daily Visits
Patient Education
Heart failure disease process and self-care Heart failure zones Medications used to treat heart failure The role of sodium and fluids worsening heart
failure Sleep apnea Oxygen therapy
Patient Education
Other chronic conditions and heart failure Heart rhythm problems Cardiac rehabilitation Advanced care planning Dietary action plan Smoking cessation Importance of daily weights
Results
Results
Total Patients Enrolled 1,438
Total Patients Readmitted 35
Overall Heart Failure Navigator
Patient Readmission Rate
2.4%
Conclusions
The heart failure navigator program has resulted in a low readmission rate.
Due to the success of the heart failure navigator program, Wellmont Health System has implemented navigator programs for other diagnoses : chronic obstructive pulmonary disease, pneumonia, and cardiopulmonary artery bypass graft.
References
1. Readmissions and Deaths: National. Centers for Medicare and Medicaid Services. Published December 18, 2016. Accessed January 11, 2017. https://data.medicare.gov/Hospital-Compare/Readmissions-and-Deaths-National/qqw3-t4ie
2. Readmissions Reduction Program (HRRP). Centers for Medicare and Medicaid Services. Published April 18, 2016. Accessed January 11, 2017. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html
3. Heidenreich PA, Trogdon JG, Khavjou, Oa, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933-44.
4. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009; 150(3):178-87.
Contact Information
Matthew Bledsoe, PharmD, BCPS Pharmacy Clinical Coordinator/ PGY1 Pharmacy Residency Program Director Bristol Regional Medical Center 1 Medical Park Boulevard Bristol, Tennessee 37620 [email protected] 423-844-2853 (office) Amber Murdock, MBA, CPHQ Director of Quality Holston Valley Medical Center 130 W Ravine Road Kingsport, Tennessee 37660 [email protected] 423-224-6004 (office)
