Implementation of a Functional Capacity Assessment in Adult Patients with Heart Failure

Abstract

Problem & Purpose: An estimated 6.2 million American adults are diagnosed with heart failure. Efforts to reduce hospitalizations and improve outcomes include interventions to maintain health, manage symptoms, and preserve functional ability. Assigning a New York Heart Association functional class of I-IV in patients with heart failure based on activity and associated symptoms is a best practice in clinical management. One means of assessing functional capacity is the 60- foot walk test, in which walk times greater than 30 seconds are associated with heart failure patients at increased risk for hospitalization or health status decline. A lack of functional capacity assessment and documentation in patients with heart failure was identified as a practice problem in a transitional care clinic. The associated medical facility has a heart failure readmission rate that is higher than the national average, making it a focus for process improvements. The purpose of this quality improvement project was to implement the 60-foot walk test in the transitional care clinic in the Fall of 2019 to objectively assess functional capacity and target high risk heart failure patients for interventions to reduce rehospitalization. Methods: During the 12-week project period, all patients with heart failure who presented to the transitional care clinic, unless unwilling or unable, completed the 60-foot walk test to determine and document functional class. Patients who were identified as high risk for readmission were provided resources for prevention. Results: There were 84 patient encounters during project implementation. The 60-foot walk test was performed 67 times (80%) and functional class was documented 64 times (76%). There were 11 readmissions and 7/11 (64%) were identified as high risk. The average readmission rate was 13.1%, a reduction of 7.4% compared to the average readmission rate of 20.5% prior to implementation. Conclusion: The 60-foot walk test was useful in the transitional care clinic to identify heart failure patients at high risk and target them for interventions to aid in maintaining health status and reducing rehospitalization.