Emergency Department Early Alert System for Heart Failure Patients Reduces Readmissions

An emergency department (ED) early alert system has dramatically reduced readmission rates for heart failure patients at Indiana University Methodist Hospital. When patients are registered in the ED, their electronic medical record flags those patients admitted for heart failure, and activates an alert that is distributed via page, email and/or text message to an on-call heart failure team that includes four physicians, four nurse practitioners, the ED charge nurse and the heart failure team manager. The patient receives aggressive treatment starting in the ED that continues when the team arrives.

The new system has increased ED physicians comfort with aggressively treating heart failure patients and discharging them to observation at the appropriate time. It has reduced 3-day readmission rates to a mean of 18.4 percent at 12 months compared with 24.5 percent in the previous 12 months.

The study was presented at the Heart Failure Society of America annual meeting in Orlando, Fla.and reported in MedPageToday.com.

Research Brief: Rural Hospital Collaborative and HF Outcomes

This week, we'd like you to introduce you to a team of researchers at the University of Maryland and Johns Hopkins University, led by Robin Newhouse and Laura Morlock.  This team conducted a study which identified the linkages between processes of nursing care and the quality of patient outcomes, while also addressing the pressing need for mentorship in implementing evidence-based heart failure (HF) care in rural hospitals. The team conducted a randomized control trial with twenty three rural hospitals from five states in the eastern United States. In the course of their project, the team found that heart failure core measures improved significantly between 2007 and 2009, but that nursing support and staffing does not predict core measure improvement. Heart failure core measures are reported by acute care hospitals as a measure of quality care for HF patients. They found that there is no relationship between the smoking cessation core measure, nursing smoking cessation counseling activity, and patient intent to quit smoking. Finally, they found that nurses in better practice environments use more evidence-based smoking cessation interventions. This study is one of the first to focus on linkages between rural nursing and patient outcomes, and has affected the engagement of nurses in 23 rural hospitals in improvements in heart failure care. Qualitative evidence suggests profound changes in the uptake of evidence and the formation of multidisciplinary teams.

Access the research brief.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Timing of Hospital Admissions Affects Outcomes for Heart Failure Patients

Research results presented at the annual meeting of the Heart Failure Association of the European Society of Cardiology show that heart failure patients who are admitted to hospitals in January, on Fridays and overnight have the highest death rates and longest hospital stays. Those admitted between 6am and noon had better outcomes than patients admitted in the evening, right before the weekend or in the middle of the night.

The study, which examined 14 years of data on more than 900,000 heart failure patients at New York hospitals, suggests that staffing plays a key role in outcomes, according to David Kao of the University of Colorado School of Medicine, who led the research team.

An INQRI-funded study led by Patti Hamilton and Gretchen Gemeinhardt revealed that patients admitted to hospitals during evenings and weekends ("off-peak" hours) experience more health problems. Nurses who work off-peak hours report that communication with other health providers is more difficult during those hours than during peak hours, which contributes to the poorer patient outcomes.

Another INQRI study, led by Robin Newhouse and Laura Morlock, and recently published in Medical Care, found that rural hospitals with lower nurse turnover and better practice environments were better able to implement a quality collaborative intervention aimed at improving care for heart failure patients.

Nurse Staffing Matters - New INQRI Study

A study led by Robin Newhouse and Laura Morlock published in the current issue of Medical Care underscores the importance of  nurse staffing in providing quality care. The researchers tested in 23 ruaral hospitals a quality collaborative intervention to improve care for heart failure patients.

The intervention focused on four key measures of heart failure care. At the end of the study, the researhceers found no quantitative difference between the intervention and control groups on implementation of the key measures. They did find that hospitals with more stable nurse staffing - lower turnover - implemented more of the measures. 

The researchers assert that the study speaks to the central role of nurses in quality improvement.

INQRI Grantee Presents as Part of Health Policy Seminar Series

INQRI grantee Doug Wholey recently presented the results of his INQRI project, "Multidisciplinary Organization and Outcomes for Chronic Heart Failure Patients in the VA" during the University of Minnesota's Health Policy and Management Seminar and Lecture Series.

Wholey co-led a team with Joanne Disch to test a theory of the effect of nurse-physician co-leadership, the effective modeling by nurses and physicians of individual role behaviors and a strong shared inter-professional relationship, in chronic heart failure (CHF) care groups in Veterans Health Administration (VHA) medical centers. The outcomes were waste in care processes, patient outcomes of receiving dietary and medication instructions at discharge, adult smoking cessation advice/counseling, and readmissions and provider outcomes of nurse burnout and CHF knowledge.

Click here to watch the presentation.

INQRI Research Team the First Commissioned by ANCC

An INQRI team from University of Maryland School of Nursing and Johns Hopkins University is the first to lead a study commissioned by the American Nurses Credentialing Center (ANCC). The team includes Robin Newhouse, PhD, RN, Laura Morlock, PhD, Cheryl Dennison, PhD, RN, Peter Pronovost, MD, PhD, Kevin Frick, PhD, Yulan Liang, PhD, Meg Johantgen, PhD, RN and Sue Thomas, PhD, RN.

In their INQRI study, this interdisciplinary research team evaluated the effects of a rural hospital collaborative established to facilitate translation of evidence on heart failure (HF) patient care. Specifically, the team examined nursing characteristics that are associated with improvements in HF patient care.  The ANCC study will extend research conducted through their INQRI study in a sample of 46 Magnet® recognized healthcare organizations.

The two-year grant will enable Newhouse to test nursing interventions with a direct effect on improved heart failure patient outcomes. The team will evaluate the effect of standardized education on heart failure patient care (knowledge, self care and readmissions), identify hospital and nursing characteristics that are associated with improvements in HF patient care and evaluate the cost effectiveness of nursing interventions to improve HF patient care.