Reducing Hospital Readmissions for Patients with Congestive Heart Failure Through Multidisciplinary Collaboration

Abstract

Purpose: Heart failure (CHF) is one the most common reasons for hospitalization for people over the age of 65 in the United States. According to the Centers for Medicare and Medicaid, 27% of patients with CHF are readmitted within 30 days of a hospitalization. For these patients, a hospital admission is a strong predictor of mortality and contributes a high financial burden. The Affordable Care Act introduced legislation that requires hospitals to track and reduce unplanned readmissions in an effort to better manage this financial burden. Therefore, the purpose of this pilot program was to reduce readmission in patients with CHF through an evidence based, multidisciplinary program. Description: A multidisciplinary team met regularly to bring together the most current evidence based practice for the management of patients with CHF from each of their disciplines. Team members included representatives from hospital administration, nursing, pharmacy, nutrition, case management, social work, physical and occupational therapy, physicians and nurse practitioners. These collaborative meetings lead to the development of a standardized care pathway that included standard order sets, educational materials and DME (specifically blood pressure machines and scales) and a follow up management protocol. Order sets included all current medication recommendations, required tests and measures as well as standard consults for ancillary services including PT, OT, cardiac rehab, and nutrition. Patients were given standard educational material on admission which was reviewed throughout the hospital stay by all appropriate members of the health care team. Additionally, blood pressure machines and scales were given to patients who were unable to afford them prior to discharge. Finally, after discharge from the hospital follow up calls were placed to each patient at regular intervals for up to 30 days. Summary of Use: In the five months prior to implementation of the pilot program, monthly hospital admission for CHF averaged 44 patients per month, with a readmission rate 30.4% (13). In the subsequent five months, average monthly admission remained consistent at 46 patients per month while readmissions were reduced to an average of 7.8 % (4). This represents a 74.3% reduction in readmissions. Importance to Members: Keeping patients with CHF out of the hospital is a top priority for both patients and the healthcare system as whole. This study demonstrates the value a comprehensive multidisciplinary approach to the management of these patients. Physical therapist can play a significant role in the management of these patients through structured exercise programs and lifestyle modification. Evidence suggests that patients with CHF who perform structured home exercise programs are more compliant overall with the management of their disease. Additionally, patients with heart failure demonstrate impairments in aerobic conditioning and skeletal muscle strength. Physical therapists are specifically trained to address these impairments to improve patient’s overall quality of life and reduced the likelihood of a hospital readmission.