Reducing CHF Admissions /Readmissions in a Small Hospital SettingMarilyn Burwitz, RN
The Impact of Congestive Heart Failure • 5.2 million people affected in the US • 400,000 new cases diagnosed each year • Responsible for 870,000 hospital admissions per year • 200,000 people die of CHF each year • $38.1 billion annually (predicted to rise to $44.6 billion by 2015) Family Practice Notebook (http://www.fpnotebook.com/) • What can we do?
Goals • Educate participants (and their caregivers) concerning their disease process • Decrease admission/readmissions to the hospital • Optimize medical therapy • Have 100% of inpatients with a diagnosis of CHF referred post-hospitalization • Equip participants with the necessary tools to maintain and possibly improve their personal level of optimal health.
Our Model • Combination of education and exercise • Six weeks program on a revolving basis • All participants in the program must be under the care of a primary care provider. • Optimization of medical therapy is under the direction of each individual provider. • A progress report is sent to the PCP after the initial visit, midway through the program and again at discharge. • $25 participant charge for the program
Before Getting Started • Baseline EKG (if not done in the past 2 weeks) with further work-up if ectopy is noted • Pre-entry labwork (if not done within the past 90 days) -CMP, CBC, BNP • Echocardiogram (if not done within one year prior to admission)
Managing a Chronic Disease • We can’t expect patients to manage chronic conditions such as congestive heart failure without giving them the tools to do so. • Equipping them with knowledge gives them the ability to actively participate in their own care.
Education: The Key to Success • Medical Terms and Cardiac Anatomy • CHF: What is it? • CHF Management • Sodium and Fluid • Reading Nutrition Labels • Monitoring Your Weight • Medications • The Importance of Exercise • Signs/Symptoms of Exacerbation • Tests and Interventions • Sudden Heart Failure • End-of-Life Decisions and Care
Plan • Track admissions and readmissions for CHF exacerbations for one year following completion of the program • Ongoing outcome data will be shared with the Medical Staff and the PI Committee
Thus Far… StartFinish • MET levels 1.5 -2.5 2.0-2.9 • Exercise Time 17-23 minutes 35-37 minutes • 100% of participants reported a positive improvement in their confidence level.