Impact of a nurse-managed heart failure clinic: a pilot study

2000 ◽  
Vol 9 (2) ◽  
pp. 140-146 ◽  
Author(s):  
S Paul
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Length Of Stay ◽  
Hospital Readmissions ◽  
Emergency Department Visits ◽  
Economic Management ◽  
Collection Rate ◽  
Heart Failure Clinic ◽  
Hospital Days

BACKGROUND: One approach to optimize clinical and economic management of congestive heart failure is the use of multidisciplinary outpatient clinics in which advanced practice nurses coordinate care. One such clinic was developed in 1995 at a southeastern university hospital to enhance management of patients with chronic congestive heart failure. OBJECTIVES: To evaluate the effects of a multidisciplinary outpatient heart failure clinic on the clinical and economic management of patients with congestive heart failure. METHODS: Data on hospital readmissions, emergency department visits, length of stay, charges, and reimbursement from the 6 months before 15 patients joined a heart failure clinic were compared with data from the 6 months after the patients joined the clinic. RESULTS: The patients had a total of 38 hospital admissions (151 hospital days) in the 6 months before joining the clinic and 19 admissions (72 hospital days) in the 6 months afterward. The mean length of stay decreased from 4.3 days in the 6 months before joining to 3.8 days in the 6 months afterward, and the number of emergency department visits also decreased, although neither decrease was statistically significant. Mean inpatient hospital charges decreased from $10,624 per patient admission to $5893. Reimbursements were $7751 (73% collection rate) and $5138 (87% collection rate), respectively. CONCLUSIONS: Patients seemed to benefit from participation in the heart failure clinic. If a healthcare provider is available to manage early signs and symptoms of worsening heart failure, hospital readmissions may be decreased and patients' outcomes may be improved.

Emergency Department Visits Versus Hospital Readmissions Among Patients Hospitalized for Heart Failure

2022 ◽  
Author(s):  
ANAND Shah ◽  
ROBERT J. MENTZ ◽  
JIE-LENA SUN ◽  
VISHAL N. RAO ◽  
BROOKE ALHANTI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Hospital Readmissions ◽  
Emergency Department Visits

Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

2019 ◽  
Vol 39 (3) ◽  
pp. 261-267 ◽  
Author(s):  
Abyalew Sahlie ◽  
Bernard G. Jaar ◽  
Lilian Galarza Paez ◽  
Tahsin Masud ◽  
Janice P. Lea ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Length Of Stay ◽  
Peripheral Arterial Disease ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Arterial Disease ◽  
Index Admission ◽  
Peripheral Arterial

Background Hospital readmissions are common among in- center hemodialysis patients, but little is known about read-missions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. Methods Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days on dialysis) between 31 January 2011 and 30 November 2014, readmissions were defined as new hospital admissions within 30 days of index discharge. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for readmission. Results Overall, 26.8% of index admissions were followed by a readmission. Readmitted patients were more likely to have congestive heart failure (31.0% vs 25.4%; p < 0.001) and peripheral arterial disease (11.6% vs 8.6%; p < 0.001) and had longer index admission length of stay (median = 4 vs 3 days; p < 0.001) than those who were not; age, sex, and race did not differ by readmission status. After adjustment for patient and index admission characteristics, longer length of stay (≥ 4 vs < 4 days, OR = 1.48, 95% confidence interval [CI] 1.35 – 1.62), peripheral arterial disease (OR = 1.31, 95% CI 1.16 – 1.57), congestive heart failure (OR = 1.25, 95% CI 1.13 – 1.39), and ischemic heart disease (OR = 1.12, 95% CI 1.01 – 1.24) were associated with higher likelihood of readmission; index admission due to peritonitis vs other causes was associated with lower likelihood of readmission (OR = 0.80, 95% CI 0.70 – 0.92). Conclusions Our results suggest that, particularly in the absence of a PD-related cause of hospitalization such as peritonitis, PD patients may be at high risk for readmission and may benefit from closer post-discharge monitoring.

Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure

2017 ◽  
Vol 16 (8) ◽  
pp. 687-695 ◽  
Author(s):  
Youn-Jung Son ◽  
Bo Hwan Kim
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Hospital Readmissions ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
World Health ◽  
Patients With Heart Failure ◽  
Prevalence Of Anemia

Background: Anemia is a frequent comorbidity in patients with heart failure. However, the incidence of anemia in patients with heart failure varies widely, and there is limited evidence on the association between anemia and rehospitalization and on the health consequences of anemia in patients with heart failure. Aims: We aimed to identify the prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Methods: This cross-sectional study included 284 patients with heart failure diagnosed at outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained socio-demographic and clinical information, including frequency of readmissions and emergency department visits, using face-to-face interviews and medical record reviews. Results: The prevalence of anemia, defined based on World Health Organization guidelines, was 39.1% among patients with heart failure. Anemia was significantly more prevalent among patients with one or more re-admissions or emergency department visits compared with patients with no history of hospital re-admissions or emergency department visits (42.7% vs. 13.9% ( p = 0.001) and 55.1% vs. 34% ( p = 0.002) respectively). Anemia increased the risk of hospital readmission (odds ratio =8.04, 95% confidence interval, 2.19–29.54) and emergency department visit (odds ratio=2.37, 95% confidence interval, 1.22–4.60) in patients with heart failure. Conclusion: It is imperative that patients with heart failure presenting with anemia undergo appropriate nursing assessment and intervention. Future prospective studies targeting interventions to improve anemia are required to determine whether anemia influences readmission rates and emergency department visits.

P6351A point-of-care risk score predicts 30-day readmission in patients hospitalized with heart failure (HF): derivation and validation of the LENT index

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H G C Van Spall ◽  
S F Lee ◽  
T Averbuch ◽  
U Erbas Oz ◽  
R Perez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Length Of Stay ◽  
Risk Score ◽  
Prediction Models ◽  
Point Of Care ◽  
Risk Index ◽  
Emergency Department Visits ◽  
Internal Validation ◽  
Risk Prediction Models

Abstract Background Risk prediction models in heart failure (HF) are typically complex, derived retrospectively from administrative databases, and modest in their ability to discriminate between high, medium, and low risk categories. The complexity of these models makes them difficult to use at the point of care. Purpose To determine if a simple risk index using Length of hospital stay (L), number of Emergency department visits in the preceding 6 months (E), and either admission or discharge N-Terminal (NT) prohormone of Brain Natriuretic Peptide (pro-BNP) at the point of care can predict 30-day readmissions in patients hospitalized for HF. Methods This is a sub-study of the Patient-Centered Care Transitions in HF (PACT-HF) stepped-wedge cluster randomized trial. We included 772 patients hospitalized for HF at 10 Canadian hospitals. We used log-binomial regression models with Length of stay, Emergency department visits in the preceding 6 months, and either admission or discharge N-Terminal prohormone of Brain Natriuretic Peptide (NT-pro-BNP) as the predictor variables and 30-day all-cause readmission as the outcome. We derived the LENT risk score from the β-coefficients of the regression model (Fig. 1). All the models were adjusted for post-discharge services. We assessed model discrimination with C-statistics and model calibration with the net reclassification index (NRI). We used the bootstrapping approach with 100 runs for internal validation. Results The LENT index had a possible score ranging from 1 to 13 (Fig 1). Increments in the LENT risk score were associated with an increased risk of 30-day readmission; a 1-point increase in the LENT index using the admission and discharge NT-pro-BNP predicted a 23% and 19% increase in 30-day readmission risk, respectively. The internal validation produced similar results. Compared to a null model, the LE index had an NRI of 0.35 [95% CI 0.18, 0.53], and admission and discharge NT-pro-BNP further improved calibration of the LE index (NRI 0.15 [95% CI 0, 0.32] and 0.20 [95% CI 0.03, 0.37], respectively). The LENT index offered modest discrimination for 30-day readmission (C-statistic 0.64 [95% CI 0.59, 0.69]), similar to more complex risk models. Figure 1. The LENT index scoring system Conclusion A simple risk index based on Length of stay, Emergent visits, and NT-pro-BNP at the point of care can reliably predict 30-day readmissions. The LENT index offers ease of use over traditional risk prediction models. Acknowledgement/Funding Canadian Institutes of Health Research, Ontario MOHLTC, Roche Diagnostics

scholarly journals Implementation of an emergency department atrial fibrillation and flutter pathway improves rates of appropriate anticoagulation, reduces length of stay and thirty-day revisit rates for congestive heart failure

CJEM ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 392-400 ◽  
Author(s):  
David Barbic ◽  
Chris DeWitt ◽  
Devin Harris ◽  
Robert Stenstrom ◽  
Eric Grafstein ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Length Of Stay ◽  
Primary Objective ◽  
Evidence Based ◽  
Post Evaluation ◽  
Atrial Fibrillation And Flutter ◽  
The Impact

AbstractObjectivesAn evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation.MethodsThis is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians. A standardized chart review identified demographics, comorbidities, and ED treatments. The primary outcome was the rate of new AC. Secondary outcomes were ED length of stay (LOS), referrals to AFF clinic, ED revisit rates, and 30-day rates of return visits for congestive heart failure (CHF), stroke, major bleeding, and death.ResultsED AFF patients totalling 301 (129 pre-pathway [PRE]; 172 post-pathway [POST]) were included; baseline demographics were similar between groups. The rates of AC at ED presentation were 18.6% (PRE) and 19.7% (POST). The rates of new AC on ED discharge were 48.6 % PRE (95% confidence interval [CI] 42.1%-55.1%) and 70.2% POST (62.1%-78.3%) (20.6% [p<0.01; 15.1-26.3]). Median ED LOS decreased from 262 to 218 minutes (44 minutes [p<0.03; 36.2-51.8]). Thirty-day rates of ED revisits for CHF decreased from 13.2% to 2.3% (10.9%; p<0.01; 8.1%-13.7%), and rates of other measures were similar.ConclusionsThe evidence-based pathway led to an improvement in the rate of patients with new AC upon discharge, a reduction in ED LOS, and decreased revisit rates for CHF.

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