scholarly journals Implementation of an Evidence-Based Practice Discharge Medication Protocol for Heart Failure Patients to Reduce 30-Day Readmissions

2021 ◽  
Author(s):  
◽  
Dawn Onstott
Keyword(s):  
Heart Failure ◽  
Evidence Based Practice ◽  
Statistical Significance ◽  
Heart Association ◽  
Evidence Based ◽  
Post Intervention ◽  
Healthcare Budget ◽  
Discharge Medication ◽  
Intervention Protocol ◽  
The One

Practice Problem: An estimated 6.5 million American adults ≥20 years of age have heart failure (HF) and worldwide 1 to 2% of the total healthcare budget is spent on HF. To improve outcomes and streamline the treatment of HF patients, The American Heart Association (AHA) joined with the American College of Cardiology (ACC) and created the Get With The Guidelines Program (GWTG). PICOT: The PICOT question that guided this project was in adult HF patients admitted to the cardiovascular unit under the care of the hospitalist service, does implementing an evidence-based practice (EBP) discharge medication protocol for physician use based on the AHA GWTG program’s HF discharge medication protocol, compared to no standardized discharge protocol, improve patients’ 30-day readmission rate, in 12 weeks? Evidence: Evidence from 10 studies supported implementing an evidence-based GDMT tool into a standardized HF discharge medication protocol for this project. Intervention: Education and encouragement of use of the AHA GWTG discharge medication protocol for HF in the electronic health record (EHR) was provided to a group of physicians on a cardiovascular unit. The intervention was over a four-week period and pre- and post-intervention protocol use was observed with specific measures analyzed for observation of improvement. Outcome: The results determined there was minimal statistical significance, however, there was a decrease in the financial measure of the cost of HF readmissions denoting a clinical significance. Conclusion: Continued use of a guideline-based discharge medication protocol, such as the one utilized in this project, is recommended based on the results and evidence provided in this project.

scholarly journals Confronting Challenges in Reducing Heart Failure 30‐Day Readmissions: Lessons Learned With Implications for Evidence‐Based Practice

2018 ◽  
Vol 16 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Racheal L. Wood ◽  
Laurie A. Migliore ◽  
Sandra J. Nasshan ◽  
Sara R. Mirghani ◽  
Annette C. Contasti
Keyword(s):  
Heart Failure ◽  
Evidence Based Practice ◽  
Lessons Learned ◽  
Evidence Based

Academy of Nutrition and Dietetics Evidence-Based Practice Guideline for the Management of Heart Failure in Adults

2018 ◽  
Vol 118 (12) ◽  
pp. 2331-2345 ◽  
Author(s):  
Toni Kuehneman ◽  
Mary Gregory ◽  
Desiree de Waal ◽  
Patricia Davidson ◽  
Rita Frickel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Practice Guideline ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Nutrition And Dietetics

scholarly journals Evidence-based practice in primary healthcare from the managerial point of view – a national survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tobias Abelsson ◽  
Helena Morténius ◽  
Ann-Kristin Karlsson ◽  
Stefan Bergman ◽  
Amir Baigi
Keyword(s):  
National Survey ◽  
Primary Healthcare ◽  
Evidence Based Practice ◽  
Statistical Significance ◽  
Correlation Coefficients ◽  
Daily Practice ◽  
Direct Result ◽  
Evidence Based ◽  
Chi Square ◽  
Significance Level

Abstract Background The vast availability of and demand for evidence in modern primary healthcare force clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary healthcare managers play a key role in implementing these governing documents. Thus, the aim of this article is to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary healthcare managers. Methods The study is based on a national survey of primary healthcare managers, consisting of 186 respondents, recruited nationally from Sweden. The data was analysed using empirically constructed concepts and validated using factor analysis. A chi-square test was utilized to determine the statistical significance of comparisons. Associations between variables were calculated using Spearman’s correlation coefficients. All tests were two-sided, and the significance level was set to 0.05. Results A majority (97 %) of managers stated that guidelines and policy documents impacted primary healthcare; 84 % of managers observed a direct effect on daily practices. Most of the managers (70 %) stated that some adaptation was needed when new evidence was introduced. The managers emphasized the importance of keeping themselves updated and open to new information about work routines (96 %). Conclusions The study illustrates a nearly unanimous response about the influence of clinical evidence on daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date is viewed as a direct result of this effect on daily practice. An information-dense organization such as a primary healthcare organization would have much to gain from increased cooperation with regional information resources such as clinical libraries.

scholarly journals French psychiatry

2006 ◽  
Vol 3 (1) ◽  
pp. 14-16 ◽  
Author(s):  
Michel Botbol
Keyword(s):  
Evidence Based Practice ◽  
The Other ◽  
Evidence Based ◽  
Anglo Saxon ◽  
Profound Change ◽  
Policy Makers ◽  
New Model ◽  
The Common ◽  
The One ◽  
Common Profile

French psychiatry is currently facing a period of profound change, as many of what were considered its most specific characteristics and traditions have been called into question. It is therefore difficult to draw a profile of French psychiatry, because it has to take into account a radical splitting between, on the one hand, what is still the common profile of most French psychiatrists and, on the other, the new model imposed by stakeholders and policy makers who want French psychiatry to take on a more Anglo-Saxon profile, with evidence-based practice coming to the fore, for instance.

Evidence-Based Practice for Acute Decompensated Heart Failure

2004 ◽  
Vol 24 (6) ◽  
pp. 14-29 ◽  
Author(s):  
Nancy M. Albert ◽  
Cathy A. Eastwood ◽  
Michelle L. Edwards
Keyword(s):  
Heart Failure ◽  
Evidence Based Practice ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Evidence Based

scholarly journals Evaluation of a bundled care approach to preventing surgical site infections post caesarean section in an Australian Rural Hospital

2019 ◽  
Author(s):  
Michelle Bolte ◽  
Blake Knapman ◽  
Lilach Leibenson ◽  
Jean Ball ◽  
Michelle Giles
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Statistical Significance ◽  
Elective Caesarean Section ◽  
Surgical Site Infections ◽  
High Risk Population ◽  
Evidence Based ◽  
Post Intervention ◽  
Care Approach ◽  
Evidenced Based

Abstract Background Elective and non-elective caesarean section (CS) rates have been increasing in Australia over the past 20 years. Increasing antenatal morbidity, has meant that surgical site infection (SSI) post CS is an important issue effecting Australian women. Populations most impacted include low socioeconomic and regional communities where high rates of antenatal comorbidity increase the incidence of SSI. Despite a recent trend towards supporting the development of evidence based bundled approaches to SSI reduction, there remains a paucity of data proving efficacy and supporting bundle implementation. Aims This study aimed to develop, implement and assess an evidence based caesarean infection prevention “CIP” bundled intervention to reduce SSI rates following CS in a high risk rural population. Methods The study was a pre-post-intervention study with 3 phases and included all women undergoing CS at a regional referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified all women who developed a post CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Prospective data was collected for a subsequent 12 month period on all women who underwent CS with pre and post comparative data analysis. Results A total of 710 procedures were monitored as part of the study with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent between the two time periods. Rates of CS associated SSI reduced significantly post-intervention (5.5% vs. 1.6%, p=0.007), the greatest benefit seen in class II and III obese patients (12.2% vs. 2.5%, p=0.019). Higher rates of hypertension (24% vs. 9%, p=0.01) and lower maternal age (mean age 27 vs. 30, p=0.01) were seen in patients with SSI. Rates of smoking were higher in women effected by SSI (24% vs 9%) but did not reach statistical significance. Conclusion The “CIP” bundle is an effective method of reducing caesarean associated surgical site infections in a high risk population. Our findings highlight the necessity for the development and evaluation of multifaceted, evidenced based interventions to reduce SSI in women requiring caesarean delivery.

Abstract 268: Multidisciplinary Approach to the Heart Failure Patient Significantly Improves Adherence to Evidence-Based Medicine Beyond Core Measures

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
George G Sokos ◽  
Jessica Lazar ◽  
Terri Hilliard ◽  
Evelyn Ozanich ◽  
Amresh Raina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multidisciplinary Team ◽  
Multidisciplinary Approach ◽  
Variable Cost ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Post Discharge ◽  
Post Intervention ◽  
Aldosterone Antagonists ◽  
Core Measures

Background: Adherence to heart failure core measures has been a focus of all hospitals in the past several years and has become even more important with the advent of pay for performance. Core measures address basic heart failure care, but do not include utilization of all evidence-based therapies which improve long term outcomes. We hypothesized that an in-hospital multidisciplinary heart failure (HF) management program could improve adherence to evidence-based guidelines beyond core measures. Methods: As a quality improvement initiative, we formed a multidisciplinary team to improve compliance with HF evidence-based therapy. Interventions included multiple educational sessions, discharge and post-discharge transition improvements, concurrent and post-discharge chart abstraction, revised patient education, and real-time provider education. Charts were abstracted in 525 consecutive HF inpatients between Jul 2010 and Mar 2011. Data was collected in the GWTG-HF (Outcome Inc) Registry. Pre-intervention compliance data (Jul-Sep) was compared to post-intervention (Nov-Mar) data with a paired t test and the Mann-Whitney rank sum test. Direct variable cost was analyzed for defect-free cases versus cases with defects. Results: Baseline Demographics: Mean age was 69 years, 42% female, 20% black, 55% ischemic etiology, mean LVEF=37%. Prior to the multidisciplinary intervention, overall defect-free care was excellent at over 89% (see figure) but there was a relative underutilization of aldosterone antagonists, hydralazine/nitrate therapy, CRT-D and anticoagulation for AF. Post-intervention, adherence improved to over 90% for all 8 evidence based therapies including: evidence-based beta-blocker (p=0.002), aldosterone antagonist (p<0.001), hydralazine nitrate (p=0.04), ICD placed or prescribed (p<0.001), CRT-D (p=0.002), anticoagulation for afib (p=0.04), and DVT prophylaxis (p=0.04). Mean direct variable cost per case was higher at $8249 in defect cases versus $6951 in defect-free cases. Conclusions: In this single center experience, interventions led by a HF multidisciplinary team can significantly improve adherence to evidence-based therapies, beyond core HF measures. A multidisciplinary approach to inpatient HF care has the potential to decrease HF related costs.

scholarly journals The place of Indapamide retard in the treatment of patients with left ventricular dysfunction and preserved systolic function in the presence of arterial hypertension

2013 ◽  
Vol 10 (2) ◽  
pp. 23-26
Author(s):  
S N Tereshchenko ◽  
I V Zhirov
Keyword(s):  
Heart Failure ◽  
Ventricular Dysfunction ◽  
Systolic Function ◽  
Left Ventricular ◽  
The Other ◽  
Controlled Trials ◽  
Evidence Based ◽  
Cardiac Decompensation ◽  
The One ◽  
Based Medicine

The issue of blood pressure levels is practically very important in patients with chronic heart failure (CHF). As is known, combination therapy for the latter implies the use of several groups of hemodynamically relevant agents; diuretics are an important component of CHF therapy. However, diuretics are the most unstudied medications in the treatment of patients with CHF in the context of evidence-based medicine. On the one hand, their efficacy and necessity for the treatment of patients with cardiac decompensation are beyond question and, on the other, even if you want, placebo-controlled trials using diuretics look difficult to perform.

scholarly journals Harnessing the Electronic Health Record to Actively Support Providers with Guideline-Directed Telemetry Use

2021 ◽  
Vol 12 (05) ◽  
pp. 996-1001
Author(s):  
Maya Narayanan ◽  
Helene Starks ◽  
Eric Tanenbaum ◽  
Ellen Robinson ◽  
Paul R. Sutton ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Acute Care ◽  
Low Cost ◽  
Heart Association ◽  
Evidence Based ◽  
Health Record ◽  
Post Intervention ◽  
Support Providers ◽  
Electronic Health ◽  
The Impact

Abstract Background Overuse of cardiac telemetry monitoring (telemetry) can lead to alarm fatigue, discomfort for patients, and unnecessary medical costs. Currently there are evidence-based recommendations describing appropriate telemetry use, but many providers are unaware of these guidelines. Objectives At our multihospital health system, our goal was to support providers in ordering telemetry on acute care in accordance with evidence-based guidelines and discontinuing telemetry when it was no longer medically indicated. Methods We implemented a multipronged electronic health record (EHR) intervention at two academic medical centers, including: (1) an order set requiring providers to choose an indication for telemetry with a recommended duration based on American Heart Association guidelines; (2) an EHR-generated reminder page to the primary provider recommending telemetry discontinuation once the guideline-recommended duration for telemetry is exceeded; and (3) documentation of telemetry interpretation by telemetry technicians in the notes section of the EHR. To determine the impact of the intervention, we compared number of telemetry orders actively discontinued prior to discharge and telemetry duration 1 year pre- to 1 year post-intervention on acute care medicine services. We evaluated sustainability at years 2 and 3. Results Implementation of the EHR initiative resulted in a statistically significant increase in active discontinuation of telemetry orders prior to discharge: 15% (63.4–78.7%) at one site and 13% at the other (64.1–77.4%) with greater improvements on resident teams. Fewer acute care medicine telemetry orders were placed on medicine services across the system (1,503–1,305) despite an increase in admissions and the average duration of telemetry decreased at both sites (62 to 47 hours, p < 0.001 and 73 to 60, p < 0.001, respectively). Improvements were sustained 2 and 3 years after intervention. Conclusion Our study showed that a low-cost, multipart, EHR-based intervention with active provider engagement and no additional education can decrease telemetry usage on acute care medicine services.

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