Date Approved

2016

Date Posted

12-12-2016

Degree Type

Campus Only Senior Honors Thesis

Department

Nursing

First Advisor

Sherry Bumpus

Abstract

Background: Heart failure is an epidemic in the United States, and is associated with readmission rates. In fact, HF is one of the original three diagnosis penalized by Medicare for hospitals for high readmission rates. However, many HF readmissions are either not due to HF or are unavoidable.

Purpose: The purpose of this study is to describe reason for readmission and guideline adherence of patients who were readmitted to the hospital after discharge from index hospitalization for HF.

Method: Retrospective chart audits of patients referred to BRIDGE, diagnosed with HF and readmitted within 30 days, between 09/08/2008-07/10/2010 and 08/30/13-08/14/15, was conducted. Patient readmissions were classified as either: CHF related, Cardiac non-CHF related, or non-Cardiac non-CHF related. Patient and provider adherence to ACCF/AHA HF guidelines was assessed for sodium restrictions, fluid restrictions, weight monitoring, out patient follow-up, and medication.

Results: Of 64 patients, the mean age was 70.3±10.32 years. The majority of patients were male (n=40, 62.5%) and white (n=54, 84.4%). We found that 22.6% (n=14) of patients were readmitted for non-cardiac, non-HF reasons; 58.1 % (n=36) were readmitted for HF and 18.8% (n=12) were for other cardiac reason. Guideline adherence was high (82.3% adherence vs. 17.7% non-adherence, p=.046). Where guidelines were not adhered to (n=10, 90.9%) patients were more often readmitted for HF. Providers documented providing educating on sodium restriction (77.4%), fluid restriction (54.8%), and daily weights (88.7%) often. Most patients reported compliance with sodium restrictions (79.1 %), fluid restrictions (53.2%), and daily weights (88.7%), and medications (95.2%). Attendance in the BRIDGE clinic nearly doubled from early to late time periods (32.4% versus 60.7%), suggesting that more patients are attending BRIDGE now.

Conclusion: As expected improved attendance in the BRIDGE program and guidelines usage was higher in the later time period. Of interest, is that more than 20% of readmissions were unrelated to HF and that overall compliance for both patients and providers was high. This suggests that many HF readmission may be unavoidable. Further research is needed to reassess readmission penalties resulting from the PPACA and prevent hospitals from being overly penalized.

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