Heart failure is one of the major reasons for readmissions
Laura James, RN, of WellSpan Gettysburg Hospital’s Heart Failure Clinic explains the Heart Failure Zone Tool to Susan Fissel.
One in five chronically ill older adults who leaves the hospital will return within 30 days, according to the New England Journal of Medicine.
Not only do avoidable readmissions cost Medicare more than $17 billion a year, but they are also a frightening experience for patients who suffer from conditions such as heart disease.
To help combat this issue, WellSpan’s Congestive Heart Failure Clinical Effectiveness Team (CHF-CET) developed an initiative with support from Aligning Forces for Quality – South Central PA (AF4Q-SCPA) to help address its heart failure patients’ needs across the region.
Through the initiative, patients are educated on a heart-healthy lifestyle and receive an easy-to-follow Heart Failure Zone Tool to closely monitor symptoms and weight gain, a common indicator of heart failure complication.
Having a way for patients to monitor their own care and symptoms is especially beneficial in helping to reduce readmission rates among heart failure patients.
The Heart Failure Zone Tool gives patients step-by-step directions on how to manage their care based on where their symptoms fall within the three zones.
“We implemented the use of the Heart Failure Zone Tool in our outpatient cardiac rehabilitation program for patients because heart failure is one of the biggest reasons for readmission among hospital patients,” said Susan Gillis of WellSpan Gettysburg Hospital Cardiac Rehabilitation. “We wanted to offer tools that patients could use at home to help prevent readmission and improve care.”
Green, yellow and red zones
If symptoms are in the green zone, patients are asked to continue checking weight gain and monitoring for changes.
Patients exhibiting yellow zone symptoms, such as showing signs of fluid overload, are asked to contact their physicians to adjust medications or their plan of care. When symptoms fall within the red zone, however, a visit to the emergency department is likely necessary.
Patients with limited financial resources can keep a close eye on weight gain through scales provided by a grant from AF4QSCPA, an initiative of Healthy York County Coalition and supported through the Robert Wood Johnson Foundation.
“If you gain three pounds in one day or five pounds in a week, it might be a sign that you are putting on extra fluid,” said Laura James of WellSpan Gettysburg Hospital’s Heart Failure Clinic. “Patients record their weight daily so they can be aware of how it is changing and use it as a preventative measure.”
Since the program's start, WellSpan Gettysburg Hospital, the Heart Failure Clinic, WellSpan Gettysburg Hospital Cardiac Rehabilitation and WellSpan VNA Home Care have distributed more than 30 scales to qualifying patients in support of ongoing efforts to reduce readmission rates.
Heart failure patients are using the tools and finding them helpful in monitoring symptoms and identifying potential signs of trouble.
“We are proud to support the innovative efforts of WellSpan Gettysburg Hospital and other health care providers in the region,” said Chris Amy, project director of AF4Q – SCPA.
“Working together, we can provide quality care, lower readmission rates and empower patients to play an active role in improving their health.”