Clinical Pathway for Heart Failure Decreases Readmissions

Compared to a control group of patients, acute heart failure patients in an emergency department's clinical pathway program had a 13.1% lower readmission rate.

Enrolling acute heart failure patients in a clinical pathway program reduces hospital readmissions from emergency departments without increasing time spent in the ED, researchers say.

The research, which was published this month in the American Journal of Emergency Medicine, found patients in an Acutely Decompensated Heart Failure Clinical Pathway (ADHFCP) program experienced a 13.1% decrease in hospital admission from the ED compared to a control group of patients.

A key element of the ADHFCP program, which was conducted at an academic medical center, was an immediate consultation with a cardiologist when participating patients presented at the ED, the researchers wrote.

"Improved communication between cardiologists and ED physicians through the establishment of an explicit pathway to coordinate the care of heart failure patients may decrease that population's likelihood of admission without increasing ED disposition times," they wrote.

The cardiologist consultations likely reduced admissions from the ED for two reasons, according to the researchers:

First, ADHFCP patients were more likely to receive diuretics than the control group of patients, and diuretics were given in higher quantities to ADHFCP patients. "These differences in care may have helped reduce the need to admit these patients," the researchers wrote.

Second, meeting with a staff cardiologist likely boosted the confidence of ED physicians to discharge ADHFCP patients, they wrote.

"Direct communication between the ED provider and the staff cardiologist frequently resulted in a guaranteed short-term clinic follow-up visit. Knowing these patients would be re-evaluated shortly after discharge increased the comfort level of the ED providers."

In addition to the cardiologist consultation, the ADHFCP program had four primary components:

• Cardiology follow-up appointments a week after discharge
   
• Primary care appointments two weeks after discharge
   
• Follow-up telephone calls at 3, 7, 14, and 21 days after discharge
   
• More care visits at the discretion of clinicians

Medicare's Hospital Readmission Reduction Program (HRRP), which penalizes hospitals financially for high readmission rates, includes heart failure as one of its 20 targeted conditions.

Heart failure is a prime area of concern for hospitals seeking to lower readmissions, the researchers wrote. "One of the HRRP's diagnoses of interest was congestive heart failure, which clearly merits focus for readmission reduction. Approximately 550,000 individuals are diagnosed with heart failure a year."

In addition to lowering readmissions, the researchers found that ADHFCP patients did not spend more time in the ED than the control patients.

"While the difference between the time spent between ADHFCP patients and control patients was not statistically significant, patients in the program actually spent slightly less time than controls, suggesting that the program may have even saved time in the ED," the researchers wrote.