Medical Center Revamps Practices to Keep Heart Patients Out of Hospital

UCSF Medical Center has been awarded more than half a million dollars to create a new system for discharging elderly heart failure patients from its hospitals, with the ultimate goal of a 30 percent reduction in hospital readmissions by December 2009. The $575,000 grant from the Gordon and Betty Moore Foundation has already allowed for some significant changes to the medical center’s practices regarding heart patients over age 65, said Maureen Buick, medical center director of nursing education and performance improvement. In November, for example, UCSF Medical Center hired two heart failure discharge coordinator nurses, Maureen Carroll and Eileen Brinker, whose primary focus will be preparing heart failure patients and their families for discharge from the hospital and following up with them in the ensuing weeks and months. The Moore Foundation grant is responding to a problem that exists not only at UCSF, but at hospitals around the country, Buick said. In 2007, 22 percent of UCSF’s heart failure patients over age 65 returned to the hospital within 30 days, and 44 percent returned within three months, she said. “We’re seeing high readmission rates, but our rates are pretty much in sync with what’s going on across the nation,” she said. “We see patients who are readmitted multiple times within the first few months.” Studies have shown that the vast majority of hospital readmissions are potentially preventable — caused mainly by poor communication with patients during the discharge process. To bring those numbers down at UCSF, a group of more than 30 people across the medical center will educate patients about what to expect once they get home and how they need to change their behaviors. Communicating those instructions to elderly individuals will require special considerations, said Karen Rago, administrative director of UCSF Heart and Vascular Center and executive director of service line administration. “You have to take into account their cognitive level — are they really understanding what you’re telling them?” she said. “You also have to look at whether they can do all the things they need to do to stay on track, such as weighing themselves and keeping up with their medications.” Because so many patients will rely heavily on outside support once they get home, the medical center team also will work with family members and other caregivers to make sure that they, too, are well informed. “We’re focusing on handoff communication — connecting not only with family members, but with health care providers out in the community,” Buick said. “We think this program will help the patients and also help us see how we teach our patients to take care of themselves.” UCSF’s success will be measured not only anecdotally, but also by the numbers it produces over the next two years. The Moore Foundation has requested monthly submissions of readmission figures and patient satisfaction surveys, and has set two ambitious goals: a 15 percent reduction in 30-day readmissions by June 15, 2009, and a 30 percent drop in both 30-day and three-month readmissions by Dec. 1, 2009. Meeting those objectives won’t be easy, Buick acknowledged, but she said she wasn’t relying on statistics to tell her whether the changes were working. “I feel confident we will be reducing our readmission rates, but what I’m more interested in is feeling confident that we have the best practices in place,” she said. “We don’t have the best practices in place yet.” Much of the success or failure of the medical center’s efforts will depend on the patients themselves, and therefore their input is an extremely valuable part of the process, Buick added. Patients will act as advisers to the physicians, nurses, social workers and other members of the team, and will be asked for their opinions on any new teaching tools or other interventions. “These patients’ circumstances are very difficult,” Buick said. “They’re being asked to change their lifestyles, and that’s not easy to do.” UCSF was one of four Bay Area hospitals to receive discharge planning grants from the Moore Foundation, and was the only academic medical center to be selected. The foundation, based in San Francisco, is a private grant-making organization that focuses on three main areas: scientific research, environmental conservation and improving the quality of life in the Bay Area. Related Links: UCSF Medical Center Gordon and Betty Moore Foundation