Abstract 328: Heart Failure Quality Improvement at the Las Vegas VA

Background: Recently there has been a push to prevent patients admitted with acute decompensated heart failure from being readmitted to the hospital within 30 days. At the VA Southern Nevada Healthcare System, we found that congestive heart failure was the most common cause of hospital admission from January 2017 to June 2018, as well as the diagnosis with the highest 30-day readmission rate to the hospital. Objective: The goal of this project was to research the cause of heart failure readmissions at the VA Southern Nevada Healthcare System and recommend solutions to reduce the readmission rate. Methods: We obtained a list of all patients at the VA who were documented as being readmitted within 30 days for heart failure from January 2017 to June 2018. We compared each patient’s hospital management to recommendations from the American Heart Association’s (AHA) “Get with the Guidelines” heart failure quality improvement program, which lays out a specific set of evidence-based benchmarks that should be achieved for patients with heart failure before hospital discharge. Results: We identified 36 patients and analyzed their hospital courses for compliance with AHA quality improvement measures. There were ten patients who did not receive pharmacologic guideline directed medical therapy for heart failure on discharge, who were not found to have any contraindications. There were eight patients who did not have a transthoracic echocardiogram performed in the previous six months who may have benefitted from repeat left ventricular function assessment. Importantly, 16 patients were not seen at a follow up appointment within one month of discharge from the hospital. Conclusion: We presented our findings to the Chief of Medicine, nursing staff, and residents at the VA Southern Nevada Healthcare System and worked with the Systems Redesign staff to determine how to improve adherence to guidelines and obtain close follow up for patients. An acute care transition clinic was created for patients at high risk for readmission on discharge, and a cardiology nurse practitioner was asked to make follow up appointments for all patients before discharge. We also created a heart failure order set in the electronic medical record, so that providers will be more likely to follow AHA recommendations from the beginning of each admission. We plan to conduct a follow up study to determine whether 30-day readmission rates improve after our recommended measures are instituted. Our objective is to reduce 30-day readmission rates and improve patient morbidity and mortality.ve patient morbidity and mortality.