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Overview | Heart Failure Implementation Toolkit

This Implementation Toolkit is built on well-proven principles of quality improvement, personal experiences, and evidence-based medicine. A redesign in process, work flow, and information transfer and sharing is needed in order to implement effective team-based heart failure care.

This Implementation Toolkit will enable you to implement effective regimens that optimize Heart Failure Management in your institution by providing you with information on:

How to Use:

The Heart Failure Implementation Toolkit is the online version of the Heart Failure Implementation Guide and addresses in detail essential elements for reaching breakthrough levels of improvement in inpatient heart failure management. Review the How to Use portion of the room for guidance and an introduction to the information you will find in the room whether you are just beginning a quality improvement initiative or have been part of on-going improvement efforts.

Implementation Guide:

Download and print the Heart Failure Implementation Guide entitled Implementation Guide for Improvement: Optimize Inpatient Heart Failure Management which serves as the portable version of key elements of the Heart Failure Implementation Toolkit.

First Steps:

Set up your team for success. Move ahead only with the support of your institution and understanding of your environment. Know where you are going and how you will get there by setting goals and using a framework for improvement.

  1. Ensure support from the institution and obtain approval.
  2. Survey previous or ongoing efforts and resources.
  3. Clarify key stakeholders, reporting hierarchy, and approval process.
  4. Assemble an effective Multidisciplinary Team.
  5. Set general goals and a timeline.
  6. Follow a framework for improvement.

Best Practices:

Review what the literature says about inpatient Heart Failure Management. Package that knowledge into a protocol that is aligned with the scope of your project.

  1. Know what the literature says about the guidelines.
  2. Know what the literature says about the etiology of heart failure, the therapies for heart failure, and discharge planning for heart failure patients.

Analyze Care Delivery:

Diagram your current care delivery processes. Understand the inter-related steps and failure modes. View care delivery as a series of intermediate and interdependent steps leading to the clinical endpoint of interest. Recognize which steps should become targets for improvement efforts and/or should become metrics for evaluating key components of your program including heart failure management, self-management, weight monitoring, and use of specific medications such as, ACEI/ARB, Beta blocker etc.

  1. Qualitative analysis: diagram care delivery to identify steps in heart failure care that may be unnecessary or may contribute to unnecessary and non-value-added variation in practice.
  2. Quantitative analysis: analyze care outcomes.

Track Performance:

Select key metrics. Collect the data needed to track performance on these metrics. Plot and report data graphically using a run chart. Write an aim statement that will clearly identify what it is that your team has targeted to improve. Consider tracking balancing measures, so that improvement in one area is not accompanied by a decrease in performance in another area.

  1. Key metric #1: Core Measures
  2. Key metric #2: Safety Medication Usage, Polypharmacy
  3. Key metric # 3: Discharge Transition and Counseling, Readmission and Mortality
  4. Data Collection
  5. Data Reporting Using Run Charts
  6. Transform General Goals into a Metric-Specific Aim Statement

Reliable Intervention:

Start with standardizing processes and protocols for critical care settings, non-critical care settings and during care transitions.. Embed guidance from your protocols into your order sets as much as possible while integrating these tools into the flow of patient care. Then, raise performance incrementally by moving up a hierarchy of increasing reliability.

  1. Designing reliability and other methods to ensure successful implementation.
  2. Building and Implementing the protocols /order sets and comprehensive educational programs.

Continue to Improve:

Learn by testing and refining change in the clinical setting. Revise the protocols and order sets to embrace appropriate variation. Take steps to weed out inappropriate variation. Spread your improvements to other units.

  1. Learning in the clinical setting: Plan-Do-Study-Act.
  2. Spreading improvement to other units.

Why Should You Act?Click to expand

  • The majority of heart failure (HF) patients are managed by hospitalists.1
  • Heart Failure is the most common diagnosis in hospitalized patients older than 65 and one-third of patients hospitalized for HF are readmitted to the hospital within 3 months2, 3. Despite advances in diagnosis and treatment of HF, over one million patients are hospitalized every year.3
  • The quality of care for hospitalized HF patients differs significantly by hospitals and physicians and adherence to evidence-based guidelines is very low. Studies have shown that admissions for HF can be prevented with multidisciplinary disease management strategies1, 2, 3

1Quality of Care for Patients Hospitalized With Heart Failure
Assessing the Impact of Hospitalists Peter K. Lindenauer, MD, MSc; Rona Chehabeddine, MPH; Penelope Pekow, PhD; Janice Fitzgerald, MS, RN; Evan M. Benjamin, MD Arch Intern Med. 2002;162:1251-1256

2Gwadry-Sridhar FH, Flintoft V, Lee DS, et al. A systematic review and meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure. Arch Intern Med 2004;164:2315-20.

3 Heart Disease and Stroke Statistics--2006 Update. A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006 Jan 11; [ PubMed]

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Fundamental Principle for Heart Failure

Hospitalists can lead their institutions in early diagnosis, initiation of evidence based medical therapy, and incorporation of a multidisciplinary approach to heart failure. Hospitalists can also develop strategies to operationalize cost-effective interventions that reduce morbidity, mortality, readmission rates and length of stay.1, 4

1Quality of Care for Patients Hospitalized With Heart Failure
Assessing the Impact of Hospitalists Peter K. Lindenauer, MD, MSc; Rona Chehabeddine, MPH; Penelope Pekow, PhD; Janice Fitzgerald, MS, RN; Evan M. Benjamin, MD Arch Intern Med. 2002;162:1251-1256

2Gwadry-Sridhar FH, Flintoft V, Lee DS, et al. A systematic review and meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure. Arch Intern Med 2004;164:2315-20.

3 Heart Disease and Stroke Statistics--2006 Update. A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006 Jan 11; [ PubMed]

4The Role of Hospitalists in the Management of Acute Decompensated Heart Failure.Alpesh N Amin MD, MBA. The American Heart Hospital Journal 2005:3 (2), 111-117

Heart Failure implementation toolkit Project Team 
This implementation toolkit is supported in part by an educational grant from Scios, Inc.
Disclaimer
The Heart Failure implementation toolkit is an online resource for visitors to the Society of Hospital Medicine’s website. All content and links have been reviewed by the Heart Failure implementation toolkit Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.