A Standardized Discharge Protocol for Heart Failure Patients to Reduce Hospital Readmissions

Abstract

Problem & Purpose: Heart failure (HF) is an incurable chronic condition and a leading cause of hospitalizations and readmissions. Nurses and other healthcare professionals on a cardiac progressive care unit (CPCU) in a large academic center have provided patients with discharge education for managing HF, based on individual knowledge. However, inconsistent patient education can lead to poor self-care and increased readmission rates. The purpose of this project was to implement a standardized discharge protocol, based upon HF care guidelines, for all adult patients admitted to CPCU with a diagnosis of HF to improve the discharge process and reduce 30-day hospital readmission rates. Methods: This quality improvement project was conducted over a 14-week period. The first three weeks were dedicated to educating staff nurses. A pre- and post-test was used to assess change in nurses’ knowledge of HF management. The standardized HF discharge protocol was implemented over 10 weeks. An audit tool measured weekly compliance. A system usability scale (SUS) was used to evaluate the ease of the use of the standardized HF discharge protocol. Results: Nurses’ knowledge significantly improved after education (pre-mean 76.5%, post-mean 93.7%, p<0.001). All nurses administered the discharge protocol by week 6, and 100% of the patients received the discharge protocol by week 6. Readmission rates for department of cardiology three months prior to the intervention (July, August, and September 2019) were 13.9%, 10.2%, and 13.1%, respectively. The readmission rate for October was 10.2%. The average SUS score was 86.7 (range 70-100), a grade “A” rating. Conclusion: Nurses’ knowledge improved significantly after education on HF and its management. The SUS score suggests that the standardized education protocol was easy to use and implement. Although it is too early to make any definitive conclusion, the readmission rate a month into implementation (October 2019) was 10.2%, lower than that of the previous month (September 2019) 13.1%. A standardized, evidence-based discharge process and HF patient education can positively impact HF self-management after discharge, thus improving quality of life and reducing hospital length of stay and 30-day readmission rates.