At Wise Regional Health System, congestive heart failure (CHF) is the leading cause for hospital readmission.
Hospital employees believe 40 percent of those could’ve been prevented.
“In trying to figure out why our CHF patients were coming back, we realized a lot of these patients were non-insured and low-income,” said Leah Throckmorton, assistant director of the critical care unit at WRHS. “What we found was that once they were discharged, they didn’t have the resources they needed – the means to buy their meds or transportation to follow-up appointments.
“And, they couldn’t remember what all they needed to do to maintain their health. Sure, before we discharge them we go through all that needs to be done. But they don’t always remember, and they don’t have the resources to be reminded.”
CHF is caused by heart attacks, high blood pressure, valve problems, alcohol abuse, infections, congenital defects and even unknown reasons. It occurs when a person’s heart can’t pump enough blood to meet his/her needs and results in symptoms like fatigue, shortness of breath, swelling and lightheadedness.
Treatment requires strict observance of a healthy diet, taking the necessary meds, exercise, no smoking and continued checkups.
“It’s hard enough to control,” Throckmorton said. “Add in that it costs a lot of money. But if you don’t have the funds or resources to maintain it, it only gets worse, and you end up back in the hospital.”
To help patients control the condition, which would consequently help control the hospital’s readmission numbers, Throckmorton and her boss, CCU director Charley Green, in December created a comprehensive CHF care program that focuses on patient and family education.
360 CHF Program is a multi-disciplinary approach that includes the primary care physician, nurses, paramedics, social work/case management, dietary, cardiac rehab, lab, pharmacists and cardiac specialists.
“Everyone had a role in creating this program and everyone has a role in executing it,” Throckmorton said. “Treatment is full circle – from EMS initiating treatment in the field to admissions, the ER staff, nurses all being on the same page. It goes from start to finish.”
They all help a patient “keep their heart healthy from hospital to home.” The program starts when they enter the hospital and follows them throughout their stay, then continues for 90 days after discharge.
The focus is on educating the patient on the importance of each step.
Prior to discharge, patients and their families must be able to explain CHF signs and symptoms, the importance of fluid restriction, what a cardiac diet is, their role in the program, different medications and their side effects and the vital signs that need to be monitored.
They must also be able to distinguish when it’s OK to call the doctor’s office versus going to the hospital, and they must know how to take their blood pressure, pulse and oxygen level.
As patients prepare to go home, they are presented with a “goody bag” that includes blood pressure cuffs and scales with which to take their vitals to record on a health calendar, also included.
In addition to weight, heart rate and blood pressure, the calendar also helps a patient track his/her symptoms – with a green dot denoting a good day, a yellow dot a bad day, and a red dot a worse day.
There are health tips throughout.
Other contents include a pill box to organize, and remind a patient to take, the necessary meds; a log to track physical activity; teaching materials to help a patient stop smoking and dipping; and general information.
“Unless you have the education tools, you can’t do what you’re supposed to,” Throckmorton said. “We needed a way to better educate our patients.”
Throckmorton and Green took their original plan a step further when Throckmorton wrote, pitched and received a $100,000 grant from the American Heart Association in March. WRHS was one of five North Texas hospitals to receive a portion of the AHA’s PCORI (Patient-Centered Outcome Research Initiatives) $500,0000 pool.
With the additional money, the program will offer patients education from a certified dietician, transportation assistance to doctor’s appointments, medication assistance including home and hospital delivery, custom fitness plans, advanced laboratory tests to assess cardiovascular risk profile and a data collection tool.
In addition, a monthly support group will be offered beginning next month.
“We see a burnout with CHF families,” Throckmorton said. “It’s a lifelong, disabilitating condition that can be emotionally tolling.
“Primary care doctors, cardiologists, dieticians, pharmaceutical company reps have all volunteered to speak. It will be valuable, free education face-to-face.”
Organizers will also take the opportunity to survey patients on the effectiveness of the program.
Because it was rolled out May 6, it’s difficult to gauge its success yet. But organizers said 10 patients have already enrolled.
“Both the nurse and the patient have been overwhelmingly supportive and happy to be a part of the program,” Throckmorton said. “Doctors have been great about referrals to the program, and there is so much community involvement and active-patient teaching involved that everyone is very excited to participate. Also, there’s never been anything like this or this much support for CHF, or any other diagnosis, before.”
Because there is no cure, CHF is a quality-of-life problem, and the numbers are only increasing.
Last year, Wise Regional treated 160 patients with CHF. In the first quarter of this year, they had already seen 61.
Hospital personnel expect that number to climb, but they are hopeful to see at least one number decline.
“We’re hoping the program will grow so that our readmissions will, in turn, drop,” Throckmorton said. “Our next goal is to become CHF accredited.
“We’re chest certified, stroke certified. We want to add a CHF designation to that. In order to do so, we’ll have to have a proven decrease in readmissions. This will help us do that.”
AHEAD OF THE CURVE
Here are a few self-care behaviors that can improve a congestive heart failure patient’s quality of life:
- Keep moving with everyday cleaning activities such as sweeping and dusting.
- Do something healthy like read a book or sew to relax.
- Eat whole grains, fresh fruit and veggies.
- Walk up to 30 minutes, with your doctor’s approval.
- Weigh yourself at the same time every day, and record the number.
- Avoid canned and processed foods that have a lot of fat and salt. Salt is sodium on food labels.
- Use herbs and spices instead of salt when cooking and seasoning food.
- Be active, but be smart and stop to rest when you get tired.
- Keep appointments with your healthcare provider, even when you feel well.
- Call your doctor if you gain 3 pounds in a day or 5 pounds in a week.
- Get help to quit smoking. It makes your heart work harder.
- Take all of your medicines, even when you feel well.