Abstract 15829: Process Improvement and Redesign to Statistically Reduce Heart Failure Length of Stay
Background: The burden of acute heart failure (HF) remains formidable. Length of stay (LOS) must be minimized to control costs, while still maintaining positive outcomes. Inappropriate diagnoses and the lack of coordinated care remain impediments to achieving a target LOS. Care process redesign affords an opportunity to improve LOS.
Methods: The HF program at Christiana Care Health System implemented a process improvement (PI) project in June 2009 on our 30 bed heart failure unit (HFU) to identify and correct barriers to timely discharge. Markers for increased LOS were identified based on historical data and included: O2 use, skilled nursing facility referral, IV vasoactive therapy use, absence of ACC/AHA guideline-based HF therapy, multiple co-morbidities, poor social support and depression. The HFU multi-disciplinary team engaged the nursing staff in twice daily case review rounds to identify and remedy outstanding care issues. Social Work and Case Management addressed options for the transition to home, rehabilitation, or extended care. A HF Clinical Psychologist was consulted for patients with depression and/or poor social support. Providers were engaged where ACC/AHA HF guideline and HF Core Measure compliance was lacking or when prolonged O2, IV diuretics, or IV vasoactive drug use was identified.
Results: LOS on the HFU (6 months Pre and Post project initiation) was compared via Student' t-Test for unpaired data. PI Project implementation resulted in LOS reduction of 0.76 days (p= <0.001). LOS for the subsequent 5 months, Phase II, revealed a sustainable decrease in LOS by 0.89 days(p= <0.001). See Table
Conclusions: A dedicated multi-disciplinary team, rounding twice daily on HF patients in a dedicated HFU, was able to significantly reduce LOS through the systematic identification of barriers to a timely discharge, and application of targeted interventions. Sustainability of the reduction in LOS was demonstrated beyond the pilot period.
- © 2010 by American Heart Association, Inc.