A Redesign of the Biopsy Scheduling Process: Improving Care through Standardization

S136 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 Results: A ReDS reading of 20-35% represents normal lung fluid. Readings of 35-39% represent mild volume overload while readings of 40% or greater correlate with moderate to severe volume overload, that is considered clinically significant. Table 1 shows the readings for each point-of-care setting. As can be seen in the Table, residual, clinically-significant, volume overload is common in patients at all points of care, including at the time of hospital discharge and on routine presentation to outpatient clinics. Conversely, a significant amount of HF patients who present to the ER complaining of HF symptoms do not have significant lung congestion. Discussion: Using the noninvasive ReDS technology to directly measure lung congestion, we found that clinically-significant lung congestion (ReDS >= 40%) is common among HF patients at all points-of-care. Further study is ongoing to assess the utility of employing the ReDS technology across the HF continuum to help providers more accurately assess volume status, titrate diuretics and neurohormonal therapies and improve outcomes.

374 A Redesign of the Biopsy Scheduling Process: Improving Care through Standardization Erika Demars, Celeste Williams; Henry Ford Hospital, Detroit, MI

375 Introduction: Standardization of work is the method for developing best practices. After the heart transplant team completed a gemba of the current scheduling process, we identified several opportunities for improving how we schedule office visits and endomyocardial biopsies for heart transplant recipients. Hypothesis: Developing a standardized process for scheduling office visits and biopsies for heart transplant recipients will result in safe, consistent delivery of care with less rework leading to improved quality of care as well as an increase in patient and staff satisfaction. Our goal is to see a 50% reduction in errors in office visit and biopsy scheduling over the next 6 months. Method: We implemented a process which there is a dedicated nurse communicating to the cardiac catheterization laboratory (cath lab) on a weekly basis. A master calendar was created, with dedicated days in the cath lab for transplant recipients. The nurse coordinators add their patients to the master calendar. Every week, two consecutive months of biopsies needed are sent to the cath lab scheduler. The medical assistants also receives information so pre-biopsy clinic visits are scheduled. The central authorization team is made aware and provided the tentative schedule in order for authorization to be obtained for multiple procedures to avoid delays in scheduling the biopsy procedure. In advance, we provide the patients with potential dates of their biopsy procedure. All communication regarding biopsy scheduling and medication adjustments are made in one phone call to patients. Results: There was a significant decline in scheduling errors for office visit from 41% to 30% over the last six months. Also we saw a decline in biopsy scheduling errors from 39% to 26%. Table 1. Marked improvement in patient satisfaction was demonstrated by a patient survey. Table 2. Conclusion: To deliver safe, reliable, effective care standardization and kaizen (continuous improvement) must occur. Implementation of our new scheduling process has resulted in more timely, efficient, effective and patient-centered care for our transplant patients.

Discontinuation Rates of Sacubitril/Valsartan at a Large, Community-Based Heart Failure Program: Demographic, Clinical and Payer Origin Associations Varun Dobariya, Vijay U. Rao, Keem Patel, Kathy Kioussopoulos, Susan Nicoson, Ashley Titus, Teresa Stickford, Atul R. Chugh; Franciscan Health, Indianapolis, Indianapolis, IN Introduction: Despite promising results, limited data exist regarding patient characteristics leading to discontinuation of sacubitril/valsartan (S/V) in larger community centers. Methods: From July 2016 to March 2018, 193 consecutive patients prescribed S/V were identified by the Slicer/Dicer tool within EPIC EMR platform (Madison, WI). Patients who died prior to agent discontinuation were excluded from the analyses. For nominal data, Chi-squared and Fisher Exact tests were used while one-way ANOVA and linear regression models were used to explore continuous variable associations. Results: A total of 178 eligible patients were identified. Baseline patient characteristics are described in the Table. S/V discontinuation rate was 19.7% (n=35), of which 31.4% were primarily attributed to high cost of the agent (n=11), while symptomatic hypotension was the most commonly reported clinical side-effect (37.1%, n=13). Of the patients who discontinued S/V, 94.2% initiated low dose therapy. Lack of S/V dose reduction (OR: 15.1, p<0.001) and high beta-blocker dose (OR 0.26, p<0.001) were associated with lower rates of discontinuation. Continuous variables associated with S/V discontinuation included higher BUN (24.3 vs. 20.5; p=0.031) and lower number of S/V adjustments (0.5 vs. 2.2; P<0.001), while higher BNP (726.6 vs. 468.6; p=0.054) and lower diastolic blood pressure [(DBP), 71.4 vs. 75.2; p=0.122] trended toward significance. Conclusion: Higher rates of S/V discontinuation were noted compared to clinical trials with high cost as a notable cause. Clinical factors such as higher BUN and BNP and lower DBP may be important