Reducing Congestive Heart Failure Hospital Readmission Through a Practice Guideline

Patients with congestive heart failure (CHF) are at increased risk for hospital readmission within 30 days of discharge. The gap in practice involves the coordination of care for patients with CHF in the transition from hospital to home. Patients with CHF are at increased risk for hospital readmission due to barriers involving self-care, communication, and coordination of care. The purpose of this project was to implement a clinical practice guideline (CPG) that used a predictive tool and clinical pathway for coordination of care for CHF patients at increased risk for hospital readmission within 30 days. The DNP project involved using the chronic care model as a framework and addressed the practice-focused question, which asked whether the CPG would be accepted by an expert panel for full implementation. The CPG was presented to a 9-member expert panel, all members of a larger QI readmission task force. There were 5 cardiac providers, and 4 nursing or administrative leaders with decision-making abilities at the site. Scores on the Agree II instrument from nine experts ranged from 5.5 to 6.81 across 23 items and 6 domains indicating overall agreement on the CPG. Recommendations of the panel included a change to the clinical practice guideline to reflect ischemic workup and criteria for admission when a patient presents to the emergency department. The expert panel agreed to full implementation of the CPG. The impact of this CPG will lead to decreased needs for hospital readmission, improved coordination of care, improved communication between the patient and the healthcare team, and empowerment of patients, leading to positive social change in terms of caring for patients with chronic CHF