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Is there a “one size fits all” strategy for reducing heart failure readmissions?
Heart & Lung xxx (2014) 1
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
AAHFN Leadership Message
Is there a “one size fits all” strategy for reducing heart failure readmissions?
Connie M. Lewis, MSN, ACNP-BC, NP-C, CCRN, CHFN
Heart Failure (HF) readmissions have captured national attention since the Center for Medicare and Medicaid Services began public reporting in 2009. Hospitals with the highest readmissions are now receiving substantial penalties and it is estimated that by 2030 HF direct and indirect cost in the US will be 160 billion dollars.1 It is not surprising that an aging population and staggering cost of care have prompt heightened sense of urgency in prevention of admissions and readmissions. We know that some readmissions are preventable and some are unavoidable. A goal should be to identify precipitating factors at the time of admission and develop interventions to address these factors before discharge. The typical HF patient is older, frail, with multiple co morbid conditions, and cognitive impairment. They may receive care from multiple providers in different settings and have limited financial, social, and care giver support. Anticipation of their needs and developing a transition plan that includes community resources may prevent readmission. There are not any “magic bullets” for reducing HF readmissions; however, there is a plethora of information in the literature on reducing 30 day readmissions. It should be synthesized and individualized to your region and institution. We need to implement guideline-directed medical therapies and transition of care systems that would improve communications across the continuum; from hospital back to the community. We should strive to learn from others, not just their successes, but also what did not work so that we do not waste our efforts on strategies that have not reduced readmissions. The focus should be on patient-centered care with optimization of transitions of care. The study by Bradley et al suggest that there are six strategies to reduce readmissions: a nurse driven medication reconciliation, partnerships with community
0147-9563/$ e see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2014.04.010
providers, partnerships with local hospitals, patient discharged with a clinic follow up appointment, a process in place to send the discharge summary to the primary care provider, and having staff assigned to follow up on test results after the patient is discharged.2 Emerging literature suggest that risk stratification tools need to be developed to identify the high risk patient that should be seen in 3e4 days instead of the recommended 7e10 days. Future studies should focus on “real time” identification of patients hospitalized for HF and the precipitating factors that lead to the hospitalization. It has also been suggested that there is a need for a global HF Registry that would standardize data collection to assist in understanding HF readmissions.3 AAHFN is uniquely positioned to lead initiatives in understanding HF readmissions. We offer regional readmission symposiums, lead by experts, to focus on solutions. There is not a “one size fits all” approach, however, there are lessons learned.
References 1. Heidenreich PA, Albert NM, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606e619. 2. Bradley EH, Curry L, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;06: 444e450. 3. Ambrosy AP, Fonarow GC, Butler J, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from HHF registries. J Am Coll Cardiol. 2014;63(12):1123e1133. http://dx.doi.org/10.1016/j.jacc.2013.11.053.
Connie M. Lewis is a Heart Failure Nurse Practitioner at Vanderbilt University Medical Center in Nashville, Tennessee. Her primary responsibilities are in the heart failure outpatient clinic. She serves as a consultant for inpatient heart failure services. Connie has developed numerous patient education tools, protocols for HF disease management, as well as worked with information systems to develop an HF Diary for ongoing outpatient communication among providers and an HF Dashboard to electronically identify patients hospitalized with a primary or secondary diagnosis of heart failure. She also serves on several committees that involve various HF initiatives: nursing electronic documentation, reducing 30 day readmissions, medical management by internal medicine. Connie presents locally, regionally, and nationally on HF topics.
Connie M. Lewis, MSN, ACNP-BC, NP-C, CCRN, CHFN, President American Association of Heart Failure Nurses Mount Laurel, NJ, USA E-mail address: [email protected]
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
AAHFN Leadership Message
Is there a “one size fits all” strategy for reducing heart failure readmissions?
Connie M. Lewis, MSN, ACNP-BC, NP-C, CCRN, CHFN
Heart Failure (HF) readmissions have captured national attention since the Center for Medicare and Medicaid Services began public reporting in 2009. Hospitals with the highest readmissions are now receiving substantial penalties and it is estimated that by 2030 HF direct and indirect cost in the US will be 160 billion dollars.1 It is not surprising that an aging population and staggering cost of care have prompt heightened sense of urgency in prevention of admissions and readmissions. We know that some readmissions are preventable and some are unavoidable. A goal should be to identify precipitating factors at the time of admission and develop interventions to address these factors before discharge. The typical HF patient is older, frail, with multiple co morbid conditions, and cognitive impairment. They may receive care from multiple providers in different settings and have limited financial, social, and care giver support. Anticipation of their needs and developing a transition plan that includes community resources may prevent readmission. There are not any “magic bullets” for reducing HF readmissions; however, there is a plethora of information in the literature on reducing 30 day readmissions. It should be synthesized and individualized to your region and institution. We need to implement guideline-directed medical therapies and transition of care systems that would improve communications across the continuum; from hospital back to the community. We should strive to learn from others, not just their successes, but also what did not work so that we do not waste our efforts on strategies that have not reduced readmissions. The focus should be on patient-centered care with optimization of transitions of care. The study by Bradley et al suggest that there are six strategies to reduce readmissions: a nurse driven medication reconciliation, partnerships with community
0147-9563/$ e see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2014.04.010
providers, partnerships with local hospitals, patient discharged with a clinic follow up appointment, a process in place to send the discharge summary to the primary care provider, and having staff assigned to follow up on test results after the patient is discharged.2 Emerging literature suggest that risk stratification tools need to be developed to identify the high risk patient that should be seen in 3e4 days instead of the recommended 7e10 days. Future studies should focus on “real time” identification of patients hospitalized for HF and the precipitating factors that lead to the hospitalization. It has also been suggested that there is a need for a global HF Registry that would standardize data collection to assist in understanding HF readmissions.3 AAHFN is uniquely positioned to lead initiatives in understanding HF readmissions. We offer regional readmission symposiums, lead by experts, to focus on solutions. There is not a “one size fits all” approach, however, there are lessons learned.
References 1. Heidenreich PA, Albert NM, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606e619. 2. Bradley EH, Curry L, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;06: 444e450. 3. Ambrosy AP, Fonarow GC, Butler J, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from HHF registries. J Am Coll Cardiol. 2014;63(12):1123e1133. http://dx.doi.org/10.1016/j.jacc.2013.11.053.
Connie M. Lewis is a Heart Failure Nurse Practitioner at Vanderbilt University Medical Center in Nashville, Tennessee. Her primary responsibilities are in the heart failure outpatient clinic. She serves as a consultant for inpatient heart failure services. Connie has developed numerous patient education tools, protocols for HF disease management, as well as worked with information systems to develop an HF Diary for ongoing outpatient communication among providers and an HF Dashboard to electronically identify patients hospitalized with a primary or secondary diagnosis of heart failure. She also serves on several committees that involve various HF initiatives: nursing electronic documentation, reducing 30 day readmissions, medical management by internal medicine. Connie presents locally, regionally, and nationally on HF topics.
Connie M. Lewis, MSN, ACNP-BC, NP-C, CCRN, CHFN, President American Association of Heart Failure Nurses Mount Laurel, NJ, USA E-mail address: [email protected]