Decreased Readmissions and Improved Quality of Care With the Use of an Inexpensive Checklist in Heart Failure

Abstract

Providing effective discharge instructions, appropriate dose uptitration, education regarding heart failure (HF) monitoring, and strict follow-up have all been shown to decrease readmissions for HF but are all underutilized. The authors developed and evaluated the impact of a quality-improvement HF checklist as a tool to remind physicians to improve quality of care in HF patients. The checklist was used in randomly selected patients admitted with a primary diagnosis of acute decompensated HF. It included documentation regarding medications and dose uptitration, relevant counseling, and follow-up instructions at discharge. The checklist was used in 48 patients, and this checklist group was compared with 48 patients as a randomly selected control group. Higher proportions of patients were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in the checklist group compared with the control group (40 of 48 vs 23 of 48, P<.001). Compared with the controls, the rate of dose uptitration for β-blockers and/or ACE inhibitors/ARBs was more common in the checklist group (4 of 48 vs 21 of 48, P<.001). Both 30-day (19% to 6%) and 6-month (42% to 23%) readmissions were lower in the checklist group. The use of an HF checklist was associated with better quality of care and decreased readmission rates for patients admitted with HF.

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients

“…Enhancing initial risk-stratification to determine when to safely discharge patients or transfer patients to alternative health care centers to avoid hospitalization is vital to conserve health care resources. Several such models have been developed and utilized with varying efficacy 28–33. Laverty et al (2015) conducted a pre- and post- implementation study involving a care bundle program involving patient education, outpatient community services, and pulmonary rehabilitation.…”

Diagnosis and management of acute heart failure

“…The remaining 48 patients were discharged in a conventional manner. The patients who were discharged using the checklist, were more likely to be on ACE inhibitors or ARBs, had a higher rate of dose uptitration for ß-blockers and/or ACE inhibitors/ARBs and demonstrated a lower 30-day (19% to 6%) and 6-month (42% to 23%) readmission rate (141). The results of this small study are promising but will have to be replicated in a randomized fashion and on a larger scale.…”

Unanticipated hospital admissions during or soon after radiation therapy: Incidence and predictive factors

“…Hospitals and physicians have responded by studying their institutional experiences to identify at-risk patients and target system-based improvements to avoid these costly readmissions. [3][4][5] Most published studies of hospital readmissions relate to internal medicine and surgical patients [3][4][5] ; however, very few studies have examined factors associated with unplanned hospital readmissions for patients with cancer. Cancer is currently the second-leading cause of death in the United States, and its treatments account for more than $200 billion in annual costs to the US health care system.…”