CCH launched an Outpatient Diuretic Program in November 2017.
Guest blogger Diana Walker is a Communications and Public Relations Specialist for Chester County Hospital.
It’s a Friday – the last day of the work week – and you’re behind. You have a major deadline due first thing Monday morning. You’ve had meeting after meeting throughout the week and when you finally get to your desk, something else pops up to take your attention. In an ideal world, you’d work through the weekend to complete your project but life intervenes – children, family obligations, house repairs – and there is just not enough time to get ahead of your workload.
Heart failure, a chronic, progressive condition that affects more than 6.7 million American adults, is a lot like not being able to keep up with your day-to-day tasks. A healthy heart pumps blood continuously through the circulatory system, delivering key nutrients and oxygen to the body. While the term heart failure makes it sound like the heart is no longer working, it actually means that the organ simply cannot keep up with its workload. As a result, the body may not get the oxygen it needs. This can lead to many symptoms including fluid buildup and water retention.
Patients living with congestive heart failure have a higher rate of hospitalization and readmission to the hospital. “These patients are very sick and have other cardiovascular and pulmonary diseases that cause them to have a weakened immune system, so when they experience an illness– like the flu or a virus – their bodies don’t have the reserve to fight off the stressors and they are admitted to the hospital on a recurrent basis,” explained W. Clay Warnick, MD, director of the Cardiovascular Program and director of Heart Failure at Chester County Hospital (CCH).
Reducing hospital readmission rates across all care areas, including heart failure, has become a national priority. As a result, the National Quality Forum has endorsed hospital risk-standardized readmission rates as performance measures and the Centers for Medicare and Medicaid Services publicly reports these statistics.
Knowing the fragility of the heart failure population, and the push to reduce readmissions, how does a health care facility continue to provide life-saving quality care to these vulnerable individuals?
In an effort to answer that question, CCH launched an Outpatient Diuretic Program in November 2017. “This outpatient treatment solution was introduced to help prevent hospital readmissions and to also keep patients in their own environment while recovering,” said Kristy Panichelli, MSN, CRNP, adding that this approach to heart failure care benefits the patient in more ways than one. “It is safer for these individuals if they are able to stay in their homes while recuperating because there are fewer risks for infections and falls.”
The nursing- and pharmacy-driven program is for individuals who have a known history of congestive heart failure and are frequently admitted to the hospital. “We see these patients in the office and they’re just not doing well,” Warnick said. “They’re not responding to their oral diuretic medication, have a buildup of fluid in the legs, abdomen, and lungs and are decompensating.”
In the past, these patients would be admitted to the hospital and given a round of intravenous diuretic therapy. This treatment method uses a furosemide infusion, which is commonly used to help remove the buildup of extra fluid that can accumulate when the heart is not working properly. With the ability to perform this treatment in an outpatient setting now in place, patients are able to receive this therapy the day after an office visit within a three to four-hour time frame. Once a patient has lost the additional fluid weight that was accumulated and is able to walk more easily, the individual is released to go home. A follow-up visit with the cardiologist is scheduled within 24 hours to see if the treatment was effective. Additionally, each of the participants are set up with a visiting care nurse to continue monitoring his or her progress.
“The program is a win-win. Patients don’t have to spend the night in the hospital and CCH is still able to administer high-quality care for these vulnerable individuals while reducing readmissions,” Warnick said.
Spearheaded by Warnick, Panichelli, and Tina Maher, BSN, MA, RN, NE-BC, director of Telemetry Services, the program is a testament to the collaboration of a multidisciplinary group at CCH.
“The staff has really embraced this initiative,” Maher said. “There is a lot to accomplish in a short amount of time with this population but the team recognized the benefits overall and every department has come together to make this a success.”
Out of the three patients who’ve gone through the program so far, none have been readmitted. Two of them have already made it past the crucial 30-day hurdle.
The program is a result of the health system’s collegiality. Lancaster General Health’s (LGH) Justin Roberts, DO, Heart Failure section chief, and Lisa Rathman, CRNP, Heart Failure program manager, helped their CCH colleagues launch this initiative by sharing protocols already in place within LGH’s own clinic, which has helped them achieve the nation’s lowest 30-day readmission rate for heart failure.
LGH’s one-day diuretic infusion treatment program began in 2016. By May of 2017, the hospital had seen such a high rate of success that they presented their findings to all University of Pennsylvania Health System entities. Warnick took that concept and began the groundwork to put CCH’s program in place. Pennsylvania Hospital also plans to leverage the success and experience of LGH’s and CCH’s programs.
“It’s a great example of how each of the institutions work in partnership and how we’re all communicating together and learning as a system,” Warnick said.
Sharon Rubin, MD, an associate professor of Clinical Medicine at Penn Medicine, echoed that sentiment. “As a Health System, we’re all tackling heart failure and readmission rates with similar patient populations. There’s a commonality to the individual hospitals but each entity also has its own identity –having the ability to learn from each other, and then tailoring those lessons to meet the needs of the individual institutions, is valuable.”