CONGESTIVE HEART FAILURERED-YELLOW-GREEN PROTOCOLANGELA ROSS, RN, BSN – PRESTIGE CARE, INC.

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StatisticsRef: Obrien, R, Paima, A & Abaga, N. Congestive Heart Failure Hospital Readmissions: Preventable or Inevitable? A Literary Review, Consultant: Volume 55, Issue 4, April

2015

• Approximately 2 million Americans aged 65 and

over reside in a long term care facility and suffer

from some form of cardiovascular disease

(Number will increase with Baby Boomers)

• Congestive Heart Failure (CHF), accounts for

approximately 17% of hospitalizations and more

than 250,000 deaths per year

• According to the CDC, 75% of hospital

admissions for CHF are patients that are 65 years

and older

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StatisticsRef: Obrien, R, Paima, A & Abaga, N. Congestive Heart Failure Hospital Readmissions: Preventable or Inevitable? A Literary Review, Consultant: Volume 55, Issue 4, April

2015

• Between 2000-2006, the rate of SNF

facility readmission to the hospital grew by

29% - All Cause

• By 2006, 23.5% of all hospital discharges

to a SNF returned directly to the hospital in

less than 30 days, costing Medicare

approximately 4.34 billion in 1 year – All

Cause

• Staggering Numbers, and has gotten a lot

of attention!!3

Changes in Health Care Payment

• Centers for Medicare & Medicaid Services

(CMS) has imposed financial penalties on

hospital systems for readmission rates

around CHF (Other diagnoses as well)

• Financial penalties will also occur for

SNF’s, along with hits to 5 Star Rating

around readmission rates

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How to Manage the Changes imposed by CMS

Ref: Obrien, R, Paima, A & Abaga, N. Congestive Heart Failure Hospital Readmissions: Preventable or Inevitable? A Literary Review, Consultant: Volume 55, Issue 4, April

2015

• Develop evidenced based strategies to

reduce hospital readmissions in patients

with CHF from the SNF

• Randomized outcome trials of SNF’s with a

designated program focused on, and,

applied interventions for CHF readmission

prevention and reduction have proven to

reduce 30 day readmission rates by 20%

to 40%

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CHF Zone Management

Tool – Utilized by

Nurse in SNF

1. Tool developed to be used

while Patient is in the SNF

2. Built into our EHR System

3. Tool put in place for all Patients

with a Diagnosis of CHF

4. Everyday:

1. Weigh Patient

2. Medication Management

3. NAS Diet

4. Monitor for Swelling, SOB,

Chest Discomfort, Difficult

Breathing, Dizziness,

Coughing, Confusion,

General Complaints

5. Balance Activities vs. Rest

6. Monitor Fluid Intake

5. Based on Tool Document and

follow the interventions listed,

example if weight gain is 3 lbs

in 1 week, the nurse would

need to contact the M.D. etc.

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CHF Weight Tracking

Calendar

1. Tool utilized to monitor patient’s

daily weight

2. Tool also utilized to document

what zone patient is in each

and every day

3. Built into our EHR system

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CHF Zone Management

Tool – Utilized by

Patient at Home

1. Tool utilized by patient at home

2. Nurse or Therapy provides

education of patient/caregiver

prior to discharge

3. Tool is utilized in the same

fashion as prior slide

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CHF Weight Tracking

Calendar – Used by

Patient at Home

1. Patient tracks daily weight and

what zone he or she is in

based on prior slide

2. Education provided at SNF

prior to discharge

3. Patient to take this to all

physician appointments

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Prestige Successes

• Readmission Rates for All Payers/All

Diagnoses/All Prestige Buildings has gone

from:

– 23% down to 12%

• CHF was our number 1 reason for return

to the hospital when we started tracking

this data in 2010

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