Purpose:

To develop a CNS-managed outpatient heart failure (HF) center.

Significance:

CNS-managed HF centers can reduce 30-day readmit rates, reduce hospital costs, decrease length of stay, and increase HF patients' quality of life scores. The CNS's holistic approach examines and impacts the multidimensional factors that exacerbate patients' HF.

Design/Background/Rationale:

Postdischarge support services are inadequate for the chronic heart failure patient. In 2004, 762 patients were discharged with a principle diagnosis of HF. The 2004 thirty-day readmission rate was 7.9%, and first quarter 2005 was 11.7%. Fifty-eight percent of patients received home healthcare post discharge, with no difference in this group's 30-day readmission rate.

Methods/Description:

The CNS conducted a literature review and examined current practice. Gaps occurred in discharge planning and follow-up. The CNS formed an HF Advisory Committee and piloted extensive HF education and phone follow-up for 2 months.

Findings/Outcomes:

One hundred thirty-nine charts were reviewed, with 43 deemed appropriate for HF teaching and follow-up. The 30-day readmission rate for these patients was 4.5%. There were no CHF-related ER visits.

Conclusions:

The positive CNS/patient relationship is instrumental in patient adherence to prescribed regimen. Focused education and phone follow-up by the CNS impacted the 30-day readmission rate and are beneficial steps toward outpatient center development.