Impact of a model of care for heart failure in-patients to reduce variation in care: a quality improvement project

Background We identified variation in delivery of guideline recommended care at our institution, and undertook a project to design a heart failure (HF) model of care. Aim To maximise time patients with HF spend well in the community by delivering best practice guidelines to reduce variation in care improving overall outcomes. Methods This quality improvement project focused on reducing variation in process measures of care. The HF model of care included electronic HF care bundles, a patient education pack with staff training on delivering HF patient education, referral of all HF patients to the Hospital Admissions Risk Program for phone call within 72 h, and a nurse-pharmacist early follow-up clinic. Outcomes were assessed using interrupted time series analyses. Results The pre-intervention group comprised 1585 patients, and post-intervention 1720 patients with a primary diagnosis of HF admitted under general cardiology and general medicine. Interrupted time series analysis indicated 30-day readmissions did not change in overall trend (-0.2% per month, P = 0.479) but a significant immediate step-down of 7.8% was seen (P = 0.018). For 90-day readmissions, a significant trend reduction over the time period was seen (-0.6% per month, P = 0.017) with a significant immediate step-down (-9.4%, P = 0.001). Emergency department representations, in-patient mortality and length of stay did not change significantly. Improvements in process measures were seen at audit. Conclusion This model of care resulted in overall trends of reductions in 30- and 90-day readmissions, without increasing emergency department representations, mortality and length of stay. This model will be adapted as the electronic medical record is introduced at our institution.

Automated summary

By designing a HF care model and implementing best practice guidelines, the readmission rates of patients can be reduced, and nursing outcomes improved. Results assessed using interrupted time series analysis showed significant improvements in 30- and 90-day readmissions, while emergency department representations, mortality, and length of stay remained unchanged. This care model will be adapted with the introduction of electronic medical records at the institution.