In 2022, we recognized the need to improve care for our patients suffering from heart failure (HF). At that time, our annual HF 30-day readmission rate was 21.56% and our 18-month HF mortality rate was 4.27%. In order to tackle this complex challenge, we developed a multidisciplinary team inclusive of hospitalist, cardiologist, chief medical officer, nurse leaders, case management, pharmacy, and quality coordinator. By utilizing the PDSA framework, we identified gaps and implemented several interventions over two years. This holistic approach has resulted in a steady reduction of HF readmissions to 11.80% and HF mortalities to 2.90%.
Problem: Since 2020, there has been a steady rise in our heart failure readmissions. There was not a standardized approach to care for this population both within the hospital and in the outpatient setting.
Measurement: We utilized a fishbone diagram to uncover many gaps in the overall care of the heart failure population within the acute care and outpatient settings. We also utilized a priority matrix to measure the ease of implementation of the interventions.
Analysis: Process measures were collected for some of the interventions based on the decision and resources of the group. We also monitored a balancing measure of heart failure mortality to ensure that patients were receiving care appropriately. We analyzed quantitative and descriptive statistics in our outcome metrics.
Implementation: We had several interventions implemented across the care continuum. Resources were an obstacle, which were mitigated by prioritizing easy wins while waiting for more resource intense interventions. Quality professionals can take utilize a holistic approach to process improvement to improve health of the heart failure population.
Results/Discussion: Our annual heart failure readmission rates decreased from 21.56% to 11.80%. The prioritization matrix was critical to our success. It was able to keep the team engaged until the next initiative rollout. We have opted to keep heart failure measures as a hospital priority to implement further identified interventions.
