Ben’s employer calls an ambulance when he shows up to his food-delivery job short of breath. Ben is taken to a nearby emergency department (ED). His wife, Alanis, rushes to the hospital. The emergency physician tells Ben and Alanis that his heart failure is worsening. They shake their heads knowingly: this is the second time they’ve gone to the hospital this year. When they ask if he will be admitted again, the doctor says, “Ben doesn’t have to be admitted this time.” Ben and Alanis breathe a sigh of relief, as they know the cost of hospitalization. But they are worried about whether the symptoms will come back, what they should do, what medications Ben should be on, and how and when they should follow up with a physician.
Patients who feel short of breath due to acute heart failure (AHF) commonly visit the ED. While there are more than 1 million hospitalizations for AHF annually, more than 200,000 patients with AHF are discharged home from the ED. Our extensive preparatory work with patients and our citizen scientists demonstrates patients discharged from the ED after a visit for AHF are often unsure about next steps, what medications they should be taking, and when they should follow up with their doctors. When patients are hospitalized, predischarge planning occurs, aimed at addressing these concerns. The Get With The Guidelines–HF (GWTG:HF) national initiative is a clear example of one of these predischarge strategies of care that has led to improved outcomes. However, no such processes are in place for patients discharged from the ED. Whether a similar initiative for discharged ED patients would also lead to improved outcomes has never been tested.
Outcomes: We aim to utilize an ED transition nurse coordinator to implement GWTG:HF, focusing on HF education, guideline-based medications, and follow up to achieve the following outcomes: (1) reduce disparities in ED and hospital revisits and death in ED-discharged AHF patients with low socioeconomic status, low health literacy and numeracy, or no insurance, or who are minorities; and (2) improve outcomes identified in our preparatory work as important to patients, including HF quality of life, HF knowledge, and patient satisfaction.
Patient and Stakeholder Engagement: In cooperation with the American Heart Association (AHA), we will continue to engage patients and stakeholders early in three ways: (1) an online community of patients reached via social media; (2) semiannual community engagement studios, to get input from the community on how to improve the study process; and (3) semiannual patient engagement meetings. All stakeholders (patients, caretakers, and payers) will share their expertise, from design and conduct to the ultimate communication of the study’s findings to the public. The AHA will play a key role in the dissemination of information based on study results.
Other Health Services Interventions
Training and Education Interventions