Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Quality Improvement

Background:

• Hospital readmissions are a significant challenge in healthcare, impacting patient well-being and healthcare system resources.
• Heart failure patients face a particularly high risk of readmission, with national rates around 23%.
• Preventable readmissions are indicators of hospital care quality.

Purpose of the Study:

• To evaluate the effectiveness of a proactive, evidence-based discharge planning bundle in reducing heart failure-related readmissions.
• To identify procedural and organizational factors contributing to heart failure readmissions.

Main Methods:

• A quality improvement project was conducted on two telemetry units.
• A four-pronged discharge bundle based on AHA, ACC, and HFSA guidelines was implemented using the plan-do-study-act framework.
• The bundle included early case management assessment, patient-centered education, predischarge medication delivery, and follow-up appointment scheduling within 7 days.
• 52 heart failure patients received the intervention over 7 weeks.

Main Results:

• The intervention reduced heart failure readmissions to 3.85% (2 out of 52 patients).
• Patients without readmissions had an average of 2.3 completed interventions, compared to 1.5 for those readmitted.
• The project demonstrated a significant decrease in readmission rates for the targeted population.

Conclusions:

• An evidence-based, four-pronged discharge planning approach effectively reduces heart failure readmissions.
• Case managers play a crucial role in care transitions and reducing readmission rates.
• There is a correlation between the number of discharge interventions and the rate of readmission.