A Supportive Heart Failure Care Program to Reduce Hospital Readmissions

Area of Science:

• Nursing
• Public Health
• Healthcare Quality Improvement

Background:

• Heart failure (HF) is a primary cause of hospital readmissions in the U.S., affecting 27% of Medicare recipients within 30 days.
• Reducing 30-day hospital readmissions for HF patients is a critical healthcare quality metric.

Purpose of the Study:

• To decrease 30-day hospital readmissions for heart failure patients under home health care.
• To evaluate the impact of a targeted educational program on HF readmission rates and nursing practice.

Main Methods:

• Developed and implemented the Supportive Heart Failure Care education program based on population assessment.
• Established agency-wide best practices and conducted nursing education sessions focused on evidence-based self-management.
• Monitored hospital readmission rates and conducted chart audits to assess practice alignment.

Main Results:

• The hospital readmission rate for heart failure patients decreased from 32% to 21% post-implementation.
• Nurses (N=35) demonstrated a 4.1% increase in knowledge regarding HF care post-education.
• Chart audits revealed inconsistent documentation of best practices among nursing staff.

Conclusions:

• The quality improvement project successfully achieved its primary goal of reducing heart failure readmissions.
• While nurse knowledge improved, translating education into consistent documented practice remains a challenge.
• Further investigation into individual and system-level barriers is necessary to optimize care for home health nurses and HF patients.