Drs. Iyengar, Graven, Boutin, Morag - Team Award

06 Aug 2017

 

The Heart Failure Affinity team was created to improve the quality of patient care, reduce the lengh of stay by 0.5 day and readmission rate by 1.7 percent with the outcome of cost reduction. They succeeded! The team implemented the following tests of change over two years and eight months:

• Inpatient cardiac order set updated with most recent evidence based care standards. Order set usage for order index one patients increased from baseline of 26 percent to 56 percent by project end.
• Heart Failure Pathway IMCU trialed on paper for over a year and implemented in Epic at project end. By June 2016, the readmission rate decreased to 14 percent on IMCU and attributed to the whole house readmission reduction to 15 percent in year three.
• Daily standing weights for heart failure patients is recommended by AHA. IMCU performed a 4SPS and discovered that standing weights for heart failure patients were obtained less than 10 percent of the time during their admission. After completion of the TOC and workflow development, greater than 97 percent of the population has daily standing weights. IMCU’s successful TOC was then shared with CVCU and other units
• Fluid weight gain and the relationship with a longer length of stay is seen in the heart failure population. To aid in diuresing and make fluid changes visible for the care team, a weight trend was created on the Input/Outputs flowsheet within Epic. To address the readmission rate the team focused the last year and half on reducing the readmission rate.

• The tests of change included: Follow up appointments with Salem Clinic or the cardiology clinics within seven days of discharge. During the Salem Clinic TOC the readmission rate decreased from 26 percent to 22 percent for the patients who kept their follow up appointment. The cardiology clinics readmission rate decreased from 16.7 percent at baseline to 15.5 percent by the end of the TOC in year three.
• Heart failure education book spread among community providers to provide consistent teaching in the hospital and community.
• Palliative care consults with Dr. James Lowry and the monthly readmission rate for these patients ranged from 0 percent to 14 percent during the TOC. The 33-month cost savings outcome for this patient population was $4.4 million with $4.1 million attributed to the reduced LOS and $300k to the decrease in readmission rate. Patients are now staying 0.65 days less than before the project began. Additionally, the 30-day readmission rate also decreased from 17.9 percent at baseline to 15.1 percent for the final nine months which is a 2.8 percent reduction and exceeded the target of 1.7 percent