heart hope: improving heart failure outcomes - kpnursing.org · initiate the hf clinical pathway by...

In 2016, Kaiser Permanente publishedthat Heart Failure is the leading cause ofhospitalization among adults 65 yearsand older. Heart Failure (HF) is a seriousdiagnosis and can be managed throughearly detection and treatment.

This project highlights the partnershipof the multidisciplinary team in thedevelopment and implementation of HFclinical pathway with standard work foreach service line providing care.

PURPOSE CONCLUSION

FUTURE PLANS

Visual Cues Identification of HF patients upon admissionHF Pathway/ChecklistInitiate the HF Clinical Pathway by the

multidisciplinary team

PROCESS

Heart Hope: Improving Heart Failure Outcomes

❖ Continue daily tracking of process measures, barrier tracking, resolution process, weekly feedback to clinicians on adherence to HF pathway.

❖ Integration with Discharge Planning project for tracking CHF patients and integration with Life Care Planning.

❖ Spread to outpatient clinics.

Vanessa A. Martinez, RN, MSN, MHAVanessa.A.Martinez@kp.orgNorthern California, Richmond

The simple approach to simplifying the education and involving the patient in their plan of care by employing a standardized tool improved their quality of life.

In 2016, the readmission rate was 22.7%, and by 3rd quarter of 2017, the rate was 7.4%. The average length of stay of CHF patients decreased from 4.6 days down to 3.5 days.

Eliminating the variability in managing their care linked all our initiatives in promoting our organizational goals for quality, safety, efficiency and patient satisfaction.

RESULTS

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Q4 - 2015 Q1 - 2016 Q2 - 2016 Q3 - 2016 Q4 - 2016 Q1 - 2017 Q2 - 2017 Q3 - 2017 Q4 - 2017

Regional Average 4.9 4.7 4.8 4.5 4.6 4.4 4.4 4.3 4.2

RCH 4.6 4.5 4.3 5.2 5 6.3 2.8 3.4 3.5

4.94.7 4.8

4.5 4.64.4 4.4 4.3 4.2

4.6 4.54.3

5.25

6.3

2.8

3.4 3.5target </= 4.5d

Heart Failure Average Length of Stay

Regional Average RCH Linear (RCH)

Visual Cues

Standardized HF Health Education❖ Your Hospital Journey❖ Managing HF at Home (Stoplight

Tool)❖ Medication Guide (Pharmacy Tool)

Process Measures

❖ Nursing implementation of frequent intake/output documentation and daily weights

❖ HBS physicians to use HF order set, fluid restriction, frequent Lasix dosing

Sustain❖ Multidisciplinary Rounds❖ Daily Process Measures Tracking❖ Barriers Identification and Resolution

Our Heart Failure hospital utilization was high, with variable physician and support staff practices in the care of our patients. The HF pathway promoted knowledge, and

empowerment of our patients that enhanced

their awareness of health and well-being.

Q4 - 2015 Q1 - 2016 Q2 - 2016 Q3 - 2016 Q4 - 2016 Q1 - 2017 Q2 - 2017 Q3 - 2017

Regional Average 18.8 18.2 19.9 18.2 21.7 14.9 17.3 12.9

RCH 12.5 19.7 23.8 21.5 22.7 17.9 13.3 7.4

18.818.2

19.9

18.2

21.7

14.9

17.3

12.912.5

19.7

23.8

21.5

22.7

17.9

13.3

7.4

target 18%

Heart Failure All Cause 30-Day Readmission Rate

Regional Average RCH Linear (RCH)

Regional QOS Heart Failure Tracking Data