1. Strategies to Decrease CHF Readmissions Beverly Jameson RN, MSN Nurse Manager Cardiac Telemetry Greenville Memorial Medical Center

2. Introduction Heart Failure has reached epidemic proportions Heart Failure is expensive Frequent readmissions

3. Causes for Readmission (in order of frequency) Non-compliance with medication regimen, diet, and/or lifestyle Progression of underlying cardiac disease Co-morbid conditions (obesity, diabetes, hypertension, renal disease)

4. GMMC Strategy: Decrease Readmissions Cohort CHF patients to the Cardiac Telemetry Unit Implement a system to review CHF Core Measure compliance daily Improve medication reconciliation using Core Measure discharge planning standards Improve patient education to decrease readmissions Improve the timeliness of physician follow-up at discharge Involve Palliative Care earlier in the disease course Solicit the buy-in of the CHF Team

5. Multidisciplinary Process Team Collaboration Oversight of the clinical course All non-ICU CHF patients are assigned to 4C Review the core measures on each CHF patient daily Medication Reconciliation (Pharmacy Pilot Project) Standing order for HeartLife and Case Management

6. Multidisciplinary Process Weekly CHF Rounds Monthly CHF Action Team Discharge Nurse Home Health Telemonitoring Post-Acute Care Management –Scales at discharge (GHS Auxiliary) –Staff Education at SNF

7. CHF Readmissions 3 rd consecutive year rated “Better than National Average” Sustained decrease in CHF readmissions All-Cause readmission rate of 19.7% (national avg 24.8) 8 th lowest overall rate in the country Readmission rate for CHF is 6.1% All-Care Measure score is 98.08%

8. Data Analysis

10. Data Analysis Secondary Diagnosis

11. Lessons Learned Staff buy-in is crucial (bedside nurses, Unit Council) Team approach is crucial – CHF management is multi-faceted Have opportunities to increase use of Palliative Care, provide discharge nurse 7 days/week, increase frequency of multidisciplinary CHF rounds, increase available technologies