Reducing 28 Day Readmission for Heart

Failure Patients BC Patient Safety Quality Council

Quality ForumFebruary 19, 2015

Suzanne Nixon MSN RN CCN(C)

Clinical Nurse SpecialistRegional Heart Failure Strategy

Summary

Background/ Context

Issue/ Problem

Strategy/ Intervention

Measurements

Ongoing challenges

Context: Burden of Heart Failure

• It is estimated that there are 500,000 Canadians living with heart failure and 50,000 new patients are diagnosed each year (Ross et al, 2006).

• Depending on the severity of symptoms, heart dysfunction, age and other factors, heart failure can be associated with an annual mortality of between 5% and 50% (Canadian Cardiovascular Society [CCS], 2006).

• Up to 40% to 50% of people with congestive heart failure die within five years of diagnosis (CCS, 2001).

Source: Heart and Stroke Foundation 2015

Population Pyramid

5

Heart Failure in BC

0

20000

40000

60000

80000

100000

120000

2001

/02

2002

/03

2003

/04

2004

/05

2005

/06

2006

/07

2007

/08

2008

/09

2009

/10

2010

/11

Incidence

Prevalence

Mortality

BC Ministry of Health, Medical Services and Health Human Resources Division, 2012

Heart Failure Costs in BC

BC Ministry of Health, Medical Services and Health Human Resources Division, 2012

The “Picture” of Heart Failure

Provincial Strategy

BC’s Heart Failure Network

• Established in early 2010

• Collaboration between Cardiac Service BC and 5 Health Authorities

• Funded by CSBC

Address the burden of HF By:

• Creating standardized HF resources

• Improving access to evidence based HF resources

• Standardizing HF care across the province

• Facilitate patients’ HF self-management

• Improving access diagnostics and HF specialist care

• Facilitating shared care across the health care continuum

Problem/Issue

2014 Report on the Health of Canadians

“Heart and Stroke Foundation’s report shows more people are surviving heart attacks and strokes, but they face challenges and lack support to thrive to the fullest”

Source: Heart and Stroke Foundation, February 2014

Problems/Issues

• Patients discharged unprepared and often unsupported

• Patients unable to self-manage - overload

• Get into trouble – come back to emergency

• 28-day readmission rates over target

Strategy/Intervention

Quality Improvement Project

Where: Cardiac Units at SPH

When: May 2014 to January 2015

What: Introduce and evolve educational tools

How: repeated PDSA cycles

Why: improve self management

Goal: to reduce 28 day re-admission rates

QA Tools

PDSA

PDSA

PDSA Cycles

• #1Information gathering

• #2 Introducing QI Project

• #3 Check–In

• #4 Monitor over time

Intervention Tools

Measurements

• Pre survey

• Post survey

• Tracking use of education tool

Heart Failure Pre-test Teaching Survey

Heart Failure Video.wmv

Heart Failure Pre and Post Teaching Survey

Heart Failure Teaching - Post Survey

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6

Reasons Given

Per

cen

tag

e

Series1

Tracking Use

Uptake of Teaching Tool

01020304050

9/16

/201

4

9/30

/201

4

10/1

4/20

14

10/2

8/20

14

11/1

1/20

14

11/2

5/20

14

12/9

/201

4

12/2

3/20

14

1/6/

2015

1/20

/201

5

Date

# o

f T

oo

ls u

sed

5A

5B

Median

Average

Ongoing Challenges

• Lack of time to spend with patient on education

• systems issues

• Complex co-morbidities and frail elderly

• Lack of coordinated sustained community support and follow-up