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How Piedmont Hospital Cut Heart Failure Patient Readmissions by 75 Percent

Jennie Mattia, RN, for HealthLeaders News, May 21, 2007
There is a serious nursing shortage in the United States. Current Joint Commission estimates project that by 2020 there will be a nursing shortfall, with at least 400,000 fewer nurses available that need to provide patient care. Moreover, according to the U.S. Bureau of Labor Statistics, jobs for nurses will grow 23 percent by 2008 (faster than the average for all other occupations) and by 2012, more than one million new and replacement nurses will be needed to support the overburdened healthcare system.

Changing demographics are signaling a need for more nurses to care for our aging population. The average American life expectancy is now about 78 years and people are staying on the job longer. As a result of work and lifestyle stresses, they are experiencing chronic health conditions much earlier than previous generations, creating a bigger drain on the healthcare system than ever before.

What does this all mean? For one thing, there are more patients and not enough healthcare professionals available to treat them in the traditional way. It’s why Fuqua Heart Center of Atlanta at Piedmont Hospital has turned to telehealth technology. Advanced telecommunications has become a way to meet the growing need for nurses and nurse practitioners.

Because of this innovative approach, I am proud to work at the Fuqua Heart Center. We offer an expansive range of cardiac services, including nationally accredited programs in cardiac rehabilitation, echocardiography and heart failure. But like most hospitals in a major population center, Fuqua understands that time is a precious commodity. The time to monitor each and every patient once they are discharged is often not available, potentially leading to additional re-hospitalizations and unnecessary emergency room visits.

In 1997, we developed a program that would address the growing needs of home-based, high-risk patients. At that time the effort involved doing physical assessments and home visits to outlying rural areas. Over time, the goal at Piedmont Hospital changed as we saw the need to increase geographical reach, serve more patients and intensify services for high-risk, chronically-ill patients. Thus the establishment of the Fuqua Heart Failure Resource Center, a full-service outpatient treatment center in 2005.

In 2004, we began our telehealth program by establishing the Community Telemonitoring Program. A key part of the Community Telemonitoring Program was to improve patient care and reduce chronic readmission through the emergency department. We began the search for a telehealth solution that would meet all our goals and still be cost-effective, user-friendly and easy to implement. We picked a local company, WebVMC in Conyers, GA. WebVMC’s RemoteNurse™ monitor uses a software-based system to transmit medical data via the Internet. When we saw a demonstration of the monitor, we were immediately struck by how simple it was to use for both staff and patients and the multiple ways it could be connected-- via a PC, laptop, smart phone or PDA. It could be used by our nurses anytime, anywhere, allowing them to be notified in real-time about readings or threshold violations that could present a potential problem for patients. This connectivity could help avert a serious condition and in some cases, eliminate the need for the patient to return for hospitalization.

The Heart Failure Resource Center installed 45 RemoteNurse units in various home locations, where patients recorded their health status every day. The patients record their weight and blood pressure as well as answer basic symptom assessment questions using peripheral devices attached to the unit. This enabled the nurses to monitor their patients remotely yet have their current statistics immediately available. The patients’ daily readings are stored on a secured web server, facilitating immediate access to trended measurements. We found that in addition to improving our patients’ overall health outcomes, the program allowed the nurses to be more efficient by having all monitored patients data available at their fingertips, thus reducing the need for individual phone follow-up. The program also generated cost savings for the hospital through lowered readmissions and emergency room visits.
The results? Hospital readmission 30 days after discharge for heart failure patients in the telehealth program were 75 percent lower than for patients not in the program, a difference of a 1.45 percent readmission rate versus a 5.85 percent readmission rate. Both figures are significantly below the national average of 20 percent for hospital readmissions for heart failure patients 30 days after discharge.
The lower readmission rates for telehealth patients were sustained over time, with only 3.6 percent of the telehealth patients requiring hospitalization at 90 days post-discharge as compared to 11 percent of patients not in the telehealth program.
Both patients and staff have given the system positive ratings. Piedmont’s Heart Failure Resource Center did a formal patient satisfaction survey six months after implementation of the WebVMC product. Of those surveyed, 100 percent rated the system as Excellent to Good overall and cited its ease of use. Several patients mentioned the empowerment they experience by self-managing their healthcare.

Many of our patients had prior experience being hospitalized and managing chronic illness by following directions from doctors and the clinic staff. They voiced overwhelmingly positive feelings that the monitor provided feelings of reassurance and a sense that someone was watching over them, someone with the knowledge to help them. By taking their own readings on a daily basis, the patients felt empowered to better self-manage their conditions. The system also offers educational resources for lifestyle, diet and exercise modifications, further enabling them to take control of their health status.

Most importantly, the physicians and the hospital management saw the benefit of the program and shouldered the cost of the monitoring fees for the telemanagement system, for which there is no charge to the patient. As a result, Piedmont Hospital has made a full commitment to continue supporting the program in the future.

We have several related proposed initiatives in the pipeline, including a plan to use the telemonitoring program to help streamline the transition of care of the inpatient population and to manage them more effectively on the outside. The latest device getting media attention is the portable defibrillator to reduce sudden cardiac death risk. Most of the Heart Failure specific devices also have remote monitoring capabilities. We have the ability to monitor devices from three major defibrillator manufacturers in the clinic.

While there are upfront costs involved in instituting a telemonitoring program, the savings from repeated hospitalizations help to justify the cost and make the investment truly worthwhile. In our case, we were able to justify the expense via a cost-avoidance model. Our 2-year return on investment estimate was met easily within the first 18 months. Through this program, we have seen how telehealth technology can help avert the anticipated nursing shortfall and serve as an effective means to treat patients and improve healthcare outcomes.


Jennie Mattia, RN, CCRN, CPHQ, is manager, Cardiovascular Quality and Heart Failure Disease Management for the Fuqua Heart Center at Piedmont Hospital in Atlanta, Georgia. For more information on the Heart Failure Resource Center’s Heart Failure Management program, visit www.fuqheartcetner.cardiologydomain.com.