Readmissions

By: Chrystal Allard

“I Pledge”
Ways to Reduce Readmissions of Heart Failure patients
 Objective

 Readmissions rates of heart failure patients will decrease by 50%

 The audience for this presentation is the CFO and CNO of Mary Immaculate
Hospital.
 The current state is that heart failure patients are being readmitted to the
hospital less than 30 days from discharge.
 Driving Force

Heart Failure is a very serious and expensive problem in the United States.
Heart failure is responsible for 43% of Medicare spending(Walker,B.2017). The
cost to treat patients with heart failure in the United States is $30.7 billion a
year (CDC 2019). There are 5.7 million people in the united States with heart
failure (CDC 2019). Half the of people diagnosed with heart failure will die within
5 years( CDC 2019). With proper education and management patients with heart
failure can live longer more productive lives. The average cost for readmission of
heart failure patient is 9,000 or 1,800 per day (Healthcare Blue Book. 2019).
(Hospital Compare 2018) shows that Mary Immaculate has a 27.1% readmission
rate for heart failure patients.
 Restraining Forces

Heart failure patients are not getting the education they need during admission
and at discharge. Patients with heart failure are at risk of being readmitting the
hospital less than 30 days from discharge. These patients are readmitted due to
lack of education, no follow up appointments with primary care providers being
made, medication reconciliations not being completed, no follow up on patient
status. Patients are not receiving proper education due to nurses being
overloaded with high nurse to patient ratios. Many patients do not have follow up
appointments scheduled with their primary care providers or cardiologists at
time of discharge. Medications are not being looked at or gone over with the
patient. Many patients do not even know why they are taking them.
 Alternative 1

The first alternative to decrease readmission rates of heart failure patients

would be to have a Clinical Nurse Specialist that educates the patients on heart
failure. This nurse would teach them about their disease, medications, diet and
exercise. They would also make follow up calls to patient when they are
discharged to check on patients.
The cost of having a clinical nurse specialist on hand to educate this patient
population would cost around $97,000 a year.
Advantage: Patients are being educated properly and have someone available to
guide them.
Disadvantage: Is the cost of training a nurse. There could be miscommunication
with the primary nurse and the CNS.
 Alternative 2

The second alternative would be to have case managers schedule post discharge
appointments. The appointments would be scheduled 3 to 5 days after discharge.
Also make sure the patient has a way to make the appointment.
Advantage: Cost nothing extra for the hospital. The sooner the patient sees their
PCP or cardiologist the better chance the patient has of staying out of the
hospital. Studies show that by offer documentation of follow up appointment and
addressing any barriers to keeping the appointment helped reduce readmission
rates (Walker, B. 2017).
Disadvantage: This could take away time from other patients that need
assistance from the case manager. Appointments may not be available when
needed or the patient may not have insurance.
 Alternative 3

The third is to have a home health visit the day after discharge to check in on
the patient and make sure they are taking their medication and are
understanding the management of their heart failure. If further visits are needed
they can be arranged. The cost for this is $125 a day (AARP 2019).
Advantage: The advantage to this alternative is that the home health nurse or
physician can assess the patients. Make sure the patient are taking their
medication properly and following their diet. They can also make sure the
patient is doing well after their hospital stay if not they can make sure the
patient seeks medical treatment. Home healthcare visit can reduce readmissions
and also reduce mortality rates (Walker,B.2017)
Disadvantage: Would be if the patient refuses to let the home health nurse.
 References
Center for Disease Control and Prevention.(2019) Heart failure fact sheet. Retrieved from:
https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
Health Care Blue Book.( 2019) Retrieved from:
https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftId=H130&g=Hospitalization+for+Heart+Failure
Hospital Compare.(2019). Retrieved from:

https://www.medicare.gov/hospitalcompare/profile.html#profTab=4&ID=490041&cmprID=490041&dist=50&loc=23602&lat=37.1120848&l
ng=-76.5372625&cmprDist=3.3&Distn=3.3
Mercer, M.(2016). You can afford a home health care worker. Retrieved from:
https://www.aarp.org/caregiving/financial-legal/info-2017/afford-a-homecare-worker.html
Salary.Com.(2019). Clinical nurse specialist salary. Retrieved from:
https://www.salary.com/research/salary/benchmark/clinical-nurse-specialist-salary/va
Walker, B.(2017). How to prevent hospital readmissions for congestive heart failure patients. Retrieved from:
https://insights.patientbond.com/blog/how-to-prevent-hospital-readmissions- for-congestive-heart-failure