Utilizing Technology for Effective Discharge Teaching to Reduce 30-Day Heart Failure Readmissions
Isabel Bracco, Tyler Burkett, Yi Foster, Megan Geon, Devin Hantin
Abstract
Description of the Issue: Heart Failure is the most
common diagnosis for 30-day hospital readmission.
St. Mary’s readmission percentage was the same as
the national rate. The aim of this project is to
reduce the 30-day rate of readmission of heart
failure patients at SMH by 1% in 1 year.
Data Analysis: Data was collected through
researching peer reviewed literature in the last ten
years related to common causes of heart failure
readmissions and gathering information from a
heart failure nurse navigator and a family nurse
practitioner specializing in heart failure at SMH.
Root Cause: Insufficient and overwhelming
discharge teaching given to the patient increased
the likelihood for readmission due to a lack of
patient understanding.
Proposed Solution: We propose to develop online
learning modules through an app and web page to
provide heart failure education in more digestible
amounts and easier to learn content.
Conclusion: Using technology for better education
strategies and encouragement of self-care will
decrease HF readmissions.
Introduction and Description of
the Issue
Macro Description: Heart failure patients currently
account for 6.2 million people, costing $25 billion. It
is projected to affect 8 million people and $70 billion
in costs to Medicare by 2030 (Park et al., 2019). Heart
Failure is the most common diagnosis for 30-day
readmission, and driven by the Hospital Readmission
Reduction Program in the Affordable Care Act
reducing payments to hospitals with excessive
readmissions (Giuliano et al., 2016).
Micro Description: Rate of readmission for heart
failure patients at St. Mary’s is no better than the
national average which is 21.9%, according to CMS
hospital comparative data.
Bon Secours Memorial College of Nursing
Data and Analysis of the Issue
● Current education includes sodium and fluid
restriction, medication adherence, recognition of
signs & symptoms, yet heart failure patients
30-day readmissions is 21.9%.
● Up to 1/2 of heart failure patients have
inadequate health literacy to master self-care (Wu
et al., 2013), which increases readmissions &
mortality rates (Fabbri et al., 2018).
● HF with low health literacy increased readmission
& mortality, so education interventions can
produce better outcomes (Wu et al., 2013).
● Studies find as Readmission Rates of HF decrease
that mortality increases, so home monitoring &
education are more important than ever.
● Lack of medication adherence is most common
cause of decompensation & readmission
(Zohrabian et al., 2018).
● HF Navigators at St. Mary’s Hospital perform 1
bedside visit and one follow-up call.
● The chart below shows how 1 additional hour
education, delivered in teaching sessions
throughout hospital stay, resulted in improved
outcomes - medication adherence, self-care, and
reduced cost of care in systolic heart failure &
reduced readmissions and costs (Koelling,T.M.,
Johnson, M.L., Cody, R.J., & Aaronson, K.D., 2009).
● Decreasing 30-day readmissions, without
increasing patient mortality, can be accomplished
by increasing the discharge teaching sessions
individualized follow-up regarding medication
adherence and self-care measures by type of
heart failure.
Root Cause
30-day readmissions for Heart Failure patients
remains a challenge in the hospital setting. We
believe that insufficient discharge teaching of
self-care, medication, and follow-up (education
reinforcement) is the root cause of readmissions.
Summary of Supporting Literature
● One study explored how to better present
information to patients about HF. The Cognitive Load
Theory suggests that “a person’s working memory is
finite, and reducing cognitive load increases the
efficiency of working memory” (Athilingam et al., 2016).
● An integrative review found with the implementation
of a multimedia app, among 130 HF patients
demonstrated a 50% decrease in 30 day HF-related
readmission. The integrative review also pointed out
that in another prior systematic review of 20 studies,
the authors concluded that the use of technologies in
managing HF patients at home had a positive impact
on hospital readmission by 45%, improved mortality
by 40%, and HF outcomes by 35% (Athilingam &
Jenkins, 2018).
● Two studies (Athilingam et al., 2016 & Foster, 2018)
implemented a mobile app for HF education. The
study’s results said that 100% of their subjects
reported the design of the mobile app was easy to
navigate and the content on HF was very appropriate
○ Also, 50% of their subjects owned a smartphone
and the 50% who did not, were able to navigate the
app and reported the app was simple and easy to
use and learn.
○ The second study also implemented the use of a
mobile application and 90% of the participants
reported the HF app enhanced their
self-monitoring.
Proposed Solution
Reduce 30-day HF readmissions at SMH by 1%
through incorporating a multimedia application to
provide additional teaching and education.
● Customized teaching for Low Health Literacy - more
sessions with less information.
● Individualized teaching by type of heart failure.
● Utilize learning modules and quizzes to identify and
direct education & reinforcement efficiently.
● Education app or web browser used on iPads or
patient’s personal device.
● Make the resource known to staff nurses with
annual training and leadership roles.
● Use grants from AHA, AHRQ, and professional
nursing organizations to cover expenses.
Logistics
•Creating online content
•Obtaining iPads
•Educating staff
•IT Supoort & Nurse Informatics
Stakeholders
•Patients and Family
•Nursing staff & HF navigators
•Hospital administration
Potential costs
•iPads/covers/screen protectors
•Cost to create online content/app
•Training staff
Timeline
•9+ months to create online content
•3 months to roll-out
•Implement by Dec. 2021
Data Collection
•HF Unit Champions collect data
•Meet quarterly with HF Navigators
•CMS evaluates hospital numbers annually
Conclusion
● CMS data (2020) showed St. Mary’s 30-day
readmission rate for HF was 21.9%, equal to the
national average.
● The discharge education for HF patients was
insufficient and the education booklet can be
overwhelming. HF is a complex, chronic diagnosis that
needs repeated education and reinforcement.
● Implementing a multimedia application to provide
additional teaching in a less complex presentation will
help increase learning and decrease readmissions.
References
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