Heart failure patients, and their doctors, have to actively coordinate their care if they hope to stay out of the hospital.
Each year one million Americans are hospitalized with heart failure, and within 30 days of going home, a quarter of them will be back in the hospital again.
Many of these 250,000 readmission are preventable, according to a study published today in the journal Circulation: Cardiovascular Quality and Outcomes. Six factors have been shown to definitively cut the rate of re-hospitalizations for heart failure, but to the researchers surprise, only 7 percent of nearly 600 hospitals surveyed used all six steps.
To reduce hospital readmission rates for heart failure, the American Heart Association has provided hospitals with two national quality improvement programs, called Get With The Guidelines – Heart Failure and Target: Heart Failure. The goal was “taking the failure out of heart failure” — a condition in which the heart cannot pump enough blood to meet the needs of the body’s organs.
Improving the quality of care for heart failure is about more than just the care a patient receives in the hospital. Key to recovery is getting proper care after discharge. Here are the steps hospitals and patients can take to ensure maximum results.
6 Steps for Hospitals to Cut Heart Failure Readmissions
Research has demonstrated that hospitals using these tactics reduce readmission rates for patients with heart failure:
- Partnering with community physicians and physician groups.
- Partnering with other local hospitals to reduce readmissions.
- Having nurses be responsible for medication reconciliation.
- Arranging follow-up appointments before patient discharge from the hospital.
- Sending all discharge papers directly to the patient’s primary physician.
- Assigning staff to follow up on test results that arrive after discharge.
It is natural to think these steps would be taken routinely, but the hospital survey results just published revealed that only 30 percent of hospitals adhered to these steps. Worse, only 7 percent followed all of them. So staying out of the hospital becomes not only the hospital’s job, but that of the patient and their loved ones.
Follow Up With Your Primary Care Doctor
“Patients and their families can be sure to follow up directly with their primary care physician after discharge and keep track of their discharge information and recommendations carefully,” said study author Elizabeth H. Bradley, PhD, professor of public health and faculty director of the Yale Global Health Leadership Institute at Yale University in New Haven, Connecticut.
After discharge from the hospital, follow up with your primary care doctor within seven days, noted Bradley.
For patients with heart failure, Stephanie Moore, MD, who specializes in heart failure, emphasized the importance of empowering patients, and agreed that follow-up must be “within one week with your primary care provider, a nurse practitioner or your cardiologist. If you are having symptoms, do not wait until the appointment, see your provider early.”
Dr. Moore is a cardiologist at the Massachusetts General Hospital (MGH) Institute for Heart, Vascular and Stroke Care’s Heart Failure and Cardiac Transplant Program in Boston.
New resources may be available for patients after hospitalization that can be helpful during the transition to home care. “At discharge, if the medical team recommends a visiting nurse, a home monitoring program or cardiac rehab, say yes! So many of my patients say no, they think they don’t need help. They do,” said Dr. Moore.
As a patient with heart failure, you can improve your prospects by accepting help from others. “Heart failure is tough to figure out on your own. It is really hard to go from hospital level care to home on your own. Bridge the gap with any services your doctor says you are eligible for, and keep your appointments,” Moore advised.
“They should not assume the hospital will communicate with their primary care physician and rather be alert themselves, to make the connections,” Dr. Bradley cautioned.
3 Steps for Patients to Coordinate Care
“I always tell my patients, I have more than 1,200 people to keep track of, you have one —you!” Moore said.
Keeping track of medications is one critical key to coordinating care from the hospital back home. “Patients are their own ‘medical home’ and ultimately responsible for providing doctors the correct med list and plan of care once it is communicated,” according to Moore.
Moore recommends patients do the following to improve their chances of staying out of the hospital:
- Update your medication list, and always date the list so you know how current it is.
- If you have a medical test, write it down along with the date and place you had it.
- Keep a copy of your providers’ business cards in a cardholder, on a smart phone App, or in a medical folder that you bring to office visits.
Following these steps will ensure you have the information your primary doctor needs for effective care after your hospital discharge, even if the hospital failed to coordinate care.
3 Tips for Transferring Test Results
Getting the results of tests done at the hospital can be a challenge after the hospital discharges a patient with heart failure. This is another process patients and families may take for granted.
But according to study author Dr. Bradley, “Patients and their families need to pay attention to what tests are taken in the hospital, and ask for results.”
“If some are still pending when they leave the hospital,” Bradley added, “remind their physicians to call for them.”
Here are more specific steps that may help in the transfer of this critical information from Moore:
- Sign a medical release with your physician’s office so they can access your tests from the hospital.
- Even better, ask for a printed copy of the test results before you leave and keep them in a folder to take with you to your next appointment.
- The best, is to ask for a CD with any important imaging tests you may have had.
“There is usually a process to this, so ask a few days before you are discharged,” Moore explained. “You may need to have a loved one go to medical records to sign a release for the information. If you ask when you are being discharged, it overwhelms the discharge process, there is so much to do!”
Because of the time needed, Moore recommended, “Start preparing for your discharge needs early.”