The Impact of a Nurse Practitioner-Led Targeted Intervention Guideline to Prevent 30-Day Readmissions Among High-Risk Heart Failure Patients: A Health Care Outcomes Project




Roberts Jnofinn, Natasha

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Heart failure (HF) is a chronic disease in which the heart muscle cannot pump enough blood to meet the body's blood and oxygen requirements. HF is a leading cause of hospitalization and readmissions in the United States, causing a public health problem affecting patients, families, and communities, contributing to increased healthcare expenditures. Recurrent readmissions have also been associated with poor self-care, suboptimal inpatient and discharge treatment, and increasing risks of morbidity, mortality, and disability, emphasizing the necessity of this quality improvement (QI) project. This DNP QI project aimed to evaluate the Nurse Practitioner's (NP) use of the American Heart Association (AHA) HF Guidelines Toolkit as a targeted intervention for high-risk HF patients at a large tertiary care facility in southern Texas. The project patients were identified using the EPIC (electronic health record) scoring system (LACE+ BOOST score), focusing on the adult high-risk HF inpatient population in the red zone. Using the AHA HF guidelines toolkit helped standardize practice in the adult high-risk HF inpatient population by reducing variability, resulting in lower readmission rates for the facility. The toolkit focused on medication management, self-management, and the lack of communication and referral/outpatient needs process. The toolkit standardizes care by promoting patient self-care, leading to enhanced inpatient and discharge management. In addition, this toolkit offers suggestions that standardize practice that helps reduce the risk of readmission for HF patients transitioning from inpatient to home care. Data comparison between the AHA HF toolkit versus no use was collected for 30-days with the ultimate goal of decreasing readmissions for the facility. The model for improvement was the framework guiding the QI project through development, testing, and change implementation. The study revealed that utilizing the AHA HF Guidelines Toolkit in the adult high-risk HF inpatient population showed a clinically significant reduction of heart failure readmissions in 30 days. The previous readmission rate was 23.1% compared to 14.8% displaying an 8.3% reduction in readmissions. Guidelines reduce practice variability by improving the quality of patient care. The AHA evidence-based guidelines toolkit for high-risk HF patients showed a clinically significant decrease in readmission rates. AHA HF guideline fills in any gaps, answers questions, promotes self-care, and helps to educate the patient on the disease process.



Heart failure, Discharge checklist, Treatment guidelines, Transitional care, Patient readmissions, Nurse practitioner, Toolkit, Health care outcomes, Targeted intervention