Bedside Education and Post Discharge Telemanagement: The Effectiveness of a Multifaceted Approach to Decrease Heart Failure Readmission Rates

Wisbiski, Kelly, Catherine Draus, Angela Budai, and Christine Sotto

Purpose of the project

Evaluate effectiveness of a multifaceted approach, incorporating focused in-hospital education with post-discharge telemanagement for the patient admitted with heart failure (HF). Methods: Random sampling of heart failure patients (N=30) admitted to a cardiac step down unit followed through to discharge. Post discharge telemanagement phone call follow-up.

Phase I (December 2007-May 2008) Piloted a heart failure education folder distributed to HF patients. Utilized a survey tool for the readability, effectiveness of information provided, and process utilized evaluated by patients and nursing staff. Initiation of education by nursing staff at time of admission, focused on what the patient and caregiver needed to know to prevent future admissions for heart failure, and improve activity tolerance. Phase II (June 2008-July 2008) Combination approach of in-patient education and post-discharge telemanagement for HF patients conducted. Telemanagement phone call by a team member which reinforced patient education related to fluid and dietary management, evaluated and reinforced medication adherence, symptom management, and physician follow-up.

Results

Phase I indicated Press Ganey score improvements in the nursing and patient evaluation of the folder. Phase II data indicated that a sicker population of HF patients was monitored which led to increased lengths of stay. When telemanagement and education were utilized together, the Press Ganey scores continued to improve. The data indicated a 3% readmission rate (1/30 patients/30 days) signifying cost effectiveness totaling $253.00 compared with costs of re-admission. Implications: A control group could be considered and follow up over 6 months and a year for future studies.