A new study suggests that improvements in heart failure care at rural hospitals can be achieved through quality improvement initiatives, although appropriate nurse staffing and a stable nursing environment are essential for success.

Figure. A nurse and patient participate in a program at Oregon Health and Science University in Portland in which patients with heart failure get extra education before they're discharged. Photo (C) Associated Press.

The researchers evaluated the effects of nurse staffing levels and practice environments on four heart failure core measures: assessment of left ventricular ejection fraction (LVEF), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) use, the provision of discharge instructions, and smoking-cessation counseling. They evaluated data from 591 RNs caring for patients with heart failure at 23 rural hospitals in the eastern United States.

The hospitals were randomly assigned to the experimental group or the control group. The intervention consisted of a two-day in-person training, an evidence-based tool kit, and monthly group teleconferences. The experimental group participated in the intervention for the first six months of the study; the control group did so after six months.

Although no significant changes in the core measures were found in either group during the intervention period, over time significant improvements were seen in the provision of discharge instructions, LVEF measurement, and ACE inhibitor-ARB use. Higher nurse turnover was related to lower adherence to all four core measures, and a better practice environment was associated with higher rates of LVEF measurement.-Karen Rosenberg

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