How to Use

Introduction and How to Use the Heart Failure Resource Room

Congratulations on your commitment to improving the care of your patients! This resource room is designed to enhance the efficiency and reliability of your quality improvement efforts in order to close the gap between best practices and what we do in caring for patients hospitalized with heart failure. This resource room is built on well-proven principles of quality improvement, personal experiences, and evidence-based medicine. A redesign in process, work flow, and information is needed In order to implement effective team-based heart failure care.

Essential elements for reaching breakthrough levels of improvement in the care of the heart failure inpatient include:

1.  Institutional support for and prioritization of this initiative, expressed as a meaningful investment of time, equipment, informatics, and personnel in the effort.

2.  A multidisciplinary team or steering committee focused on improving heart failure care of hospitalized patients.

3.  Data collection and reliable metrics that, at a minimum, reflect volume of admissions for heart failure, physicians/physician groups caring for hospitalized heart failure patients, readmission rate, length of stay, and core measure performance. These data should be transformed into reports that inform the team and frontline workers of progress being made and problem areas to address.

4.  Specific aims, or goals, that are time defined, measurable, and achievable.

5.  Standardized heart failure improvement tools that promote rational and evidence-based care of patients with heart failure.

6.  Algorithms, policies, and protocols that are institution specific and that support the order sets and promote their safest and most effective use. These tools must not merely exist; they must be widely disseminated and used and, in some cases, be embedded in the order set. A high-reliability design should be used to enhance effective implementation. These algorithms, policies, and protocols should outline and guide the caregiver’s approach to:

        a.   Identification of patients with heart failure.
        b.   Development of a plan of care at admission.
        c.   Standardization of daily rounds.
        d.   Team communication.
        e.   Patient education.
        f.    Medication safety and polypharmacy.
        g.   Palliative care and symptom management.
        h.   Device therapy.
        i.    Discharge and follow-up care.
        j.   Core measures.

How to Use the Resource Room

The resource room addresses each of these six elements in some detail. Although it is designed to assist leaders who are starting from scratch, the resource room can also benefit teams that have already made considerable progress, as it is unlikely that any institution is performing optimally in all areas. For a portable version download the Implementation Guide. We recommend that all users initially review the Essential First Steps section and the Analyze Care Delivery Section which will help you assess your current status on all the elements explained in these sections. Completing these sections first will put you in a position to proceed with good institutional support and to intelligently prioritize areas for intervention and allocation of resources.

Although we attempted to present the information in a logical order, one that mirrors a real-life approach, you and your improvement teams should not feel obligated to pore over every detail of every section or to follow the sections in the exact order they are presented. In fact, you will find it difficult to stick to one particular sequential order, and activities presented in different sections often occur in parallel in real life. Your team should eventually assess and attempt to improve the full range of quality issues involving care of the hospitalized heart failure patients.

This resource room incorporates sections of all the essential elements described above in order to achieve breakthrough improvement. In addition, we highlight important topics and improvement tools such as run charts, process mapping, and methods to hold the gains and spread your improvement methods. Methods for demonstrating financial return on investment are also presented.

The Heart Failure Resource Room provides links to guidelines, key references, and examples of order sets, algorithms, protocols, and educational materials that can be very useful to your team. One special word of caution is in order, however. We strongly discourage using these materials to build an order set or protocol that you try to implement without following the general improvement framework presented in the rest of the workbook. This framework calls for a multidisciplinary team effort, specific goals, reliable and practical metrics, and monitoring and learning from variation from your efforts. Ignoring these principles can lead to mediocre results and disillusionment.

Following these methods can enable you to demonstrate to your medical center and insurers the value of quality improvement work,  to your medical center and insurers, both because of both the outcomes obtained and because of the cost savings often inherent in higher-quality care. Demonstrating value in quality improvement and cost savings can lead to protected time for hospitalists and others to improve the quality and safety of the hospitalized patient.