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Utility of daily diuretic orders for identifying acute decompensated heart failure patients for quality improvement

Patrick T Campbell1, Joseph Tremaglio, Adarsh Bhardwaj

  • 1Cardiovascular Division, University of Connecticut Health Center, John Dempsey Hospital, 260 Farmington Ave., Farmington, CT 06030, USA. pacampbell@uchc.edu

Critical Pathways in Cardiology
|August 31, 2010
PubMed

Insights

A daily diuretic list effectively identified most acute decompensated heart failure (ADHF) patients in hospitals. This method, combined with clinical reminders, improved adherence to American College of Cardiology (ACC)/American Heart Association (AHA) guideline therapies.

Area of Science:

  • Cardiology
  • Health Informatics
  • Quality Improvement

Background:

  • Adherence to American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for acute decompensated heart failure (ADHF) is often suboptimal.
  • Identifying ADHF patients within complex hospital environments poses a significant challenge for quality improvement initiatives.

Purpose of the Study:

  • To evaluate the effectiveness of a daily loop diuretic list for identifying hospitalized ADHF patients.
  • To assess the impact of targeted clinical reminders on guideline adherence for ADHF management.

Main Methods:

  • Generated a daily list of inpatients receiving loop diuretics using an electronic order-entry system.
  • Screened patients on the diuretic list for ADHF via chart review over a 3-month period.
  • Implemented clinical reminders for ACC/AHA guideline-recommended therapies and tracked outcomes using the Get With The Guidelines database.

Main Results:

  • The diuretic list identified 98.6% of ADHF patients, demonstrating high sensitivity (98.6%) and specificity (92.2%).
  • This method surpassed alternative identification strategies like chest x-ray and brain natriuretic peptide levels.
  • The combined approach of the diuretic list and reminders improved adherence to recommended therapies, including smoking cessation and heart failure education.

Conclusions:

  • A daily inpatient diuretic list enables efficient, real-time identification of the majority of heart failure patients.
  • Targeted clinician reminders linked to this identification process significantly improved adherence to ACC/AHA heart failure guidelines.
Abstract

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