Responses to Discharge Call Center Questions among Heart Failure Patients with 30-Day Hospital Readmission

Abstract

Heart failure (HF) is one of the leading causes of hospitalization (Horwitz & Krumholz, 2018). Thirty-day hospital readmission is a problem that increases financial burden through denied reimbursements to hospitals and healthcare organizations. Society of Hospital Medicine (SHM) (SHM, 2015) recommends tracking performance measures such as documentation of left ventricular ejection fraction, patients’ compliance with discharge medications, post-discharge follow-up appointment within seven days, activity level, diet, weight monitoring, and patients’ knowledge about what to do if symptoms worsen. Discharge call center personnel at the project facility make follow-up phone calls to the HF patients on days 3, 7, 14, and 28 after hospital discharge. The purpose of this quality improvement Doctor of Nursing Practice (DNP) project was to describe the responses of HF patients to the discharge call center questions about medication compliance, following-up with the physicians, monitoring of daily weight, normal salt intake, symptoms and activities and to propose suggestions for reducing 30-day hospital readmission. Retrospective chart review was executed and data collected from 52 patients’ charts. The most important findings of this project are: (1) majority of the readmitted HF patients were men; (2) The Center for Outcomes Research and Evaluation (CORE) readmission risk was calculated in 70% of the patients; (3) nearly half of the CORE readmission risk scores were between 20 and 30%; (4) 75% of the patients age 65 or older were readmitted; (5) 96% of HF patients were readmitted for non-HF related causes; (6) Among the participants, the number of patients who were compliant with the discharge education was greater than the number of patients who were non-complaint; and (7) The reason for non-adherence with the discharge teachings were documented only for few patients. Around 35% of HF patients participated in the call center’s survey. This indicated the need to focus on ways to improve patient participation in future discharge phone calls and more effective methods to improve adherence with discharge instructions.