Issue No. 646
A Tale of Two Hospitals: Preventing Readmissions for Heart Failure Patients
Date: July 5, 2013
Heart failure accounts for more hospital admissions than any other diagnosis in patients over 65, a group that’s growing rapidly as the U.S. population ages.
Educating heart failure patients about their medications, diet/exercise restrictions and medical follow-up are important steps to prevent additional hospitalizations. All patients should receive a packet with this information before leaving the hospital—a best practice with which all U.S. hospitals must report their compliance.
Teams at Sibley Memorial Hospital and Johns Hopkins Bayview Medical Center have developed different approaches to ensure that heart failure patients are adequately prepared for the hospital-to-home transition.
Reorganizing Efforts at Sibley Memorial Hospital
In a pilot project, a clinical team at Sibley Memorial Hospital centralized heart failure patients on one unit, assigned one pharmacist to follow all of them, standardized patient education, implemented multidisciplinary rounds with the whole care team and improved assessments of postdischarge needs and follow-up after patients left the hospital. Subsequently, Sibley’s readmissions rate for this group dropped by 7 percent, and compliance with the core measure requirement to provide complete discharge instructions to all heart failure patients jumped to 100 percent.
“It’s all about coordinating our efforts,” says Caroline Collantes, telemetry nurse manager at Sibley.
Reconciling Medications at Johns Hopkins Bayview Medical Center
On average, a heart failure patient takes about a dozen different medications, each of which may be adjusted during her hospitalization, according to Amy Knight, assistant professor of medicine at Johns Hopkins Bayview Medical Center. “Making sure that home, hospital and discharge medication lists are coordinated is important for patient safety, but many hospitals do not have automated electronic systems that help providers perform this function,” Knight says.
A medical intern came up with a solution to eliminate mismatches between the handwritten medication list provided to patients at discharge and the list in the discharge summary sent to their outpatient physicians: switch to an electronically generated version for patients. The clinical team then collaborated with IT to create a way for doctors to copy and paste the medication list from the patient history in the electronic medical record into the electronic discharge summary template. This solution is now in place across the hospital.