Accountability And Driving Resilient Care Redesign
Care redesign for BHFS is driven by the EBCC initiatives. The EBCC is clinically driven and IT supported. Key stakeholders include:
- Facility Chief Executive Officers
- Center for Performance Excellence
- Interdisciplinary physician members from each Baptist Health System facility
The purpose of the EBCC is to guide BHSF in a way that allows us to adopt to constantly changing science to improve the care we give our community. Our goal is to reduce variation in care, have better outcomes and realize efficiencies as a result. Patients get access to the highest standards of care, our physicians and care givers practice the state of the art and we take unnecessary costs out of the system. Our vision is that the EBCC will ensure that the organizations healthcare providers deliver care that is deliberate and coordinated across all services, based on the latest clinical evidence, to provide superior clinical outcomes while reducing cost.
The adherence to evidence-based practice is crucial to our success. The EBCC takes pride in the responsibility of overseeing the implementation and success of our projects. Our responsibilities include:
The data to support the compliance to care is available in the DivePort analytics tool. DivePort provides data at multiple levels and is available to all key stakeholders upon completion of educational requirements .
HIMSS Davies Awards
Enhancing Healthcare Team Outcomes
This case demonstrates how all interprofessional healthcare team members need to be involved in arriving at a correct diagnosis, particularly in more challenging cases such as this one. Clinicians, specialists, nurses, pharmacists, laboratory technicians all bear responsibility for carrying out the duties pertaining to their particular discipline and sharing any findings with all team members. An incorrect diagnosis will almost inevitably lead to incorrect treatment, so coordinated activity, open communication, and empowerment to voice concerns are all part of the dynamic that needs to drive such cases so patients will attain the best possible outcomes.
Survival Analysis Of Heart Failure Patients: A Case Study
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Roles Conceptualization, Methodology, Project administration, Supervision, Writing original draft, Writing review & editing
Affiliation Department of Statistics, Government College University, Faisalabad, Pakistan
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Roles Data curation, Formal analysis, Methodology, Writing original draft
Affiliation Department of Statistics, Government College University, Faisalabad, Pakistan
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Roles Formal analysis, Investigation, Methodology, Validation
Affiliation Department of Statistics, Government College University, Faisalabad, Pakistan
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Roles Methodology, Software, Visualization, Writing review & editing
Affiliation Department of Statistics, Government College University, Faisalabad, Pakistan
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Define The Clinical Problem And Pre
The overall objective of the 30-day CMS heart failure readmission program was to create a sustainable process to successfully reduce the 30-day readmission rate in this population. Homestead Hospitals multidisciplinary committee continuously developed and evaluated action plans to improve care and decrease the 30-day readmissions, which averaged 33.3% in 2011 and have been as low as 11.1% in 2019.
In 2016, the team re-focused on readmission prevention and implemented a Plan-Do-Study-Act Initiative and as a result several new processes were implemented over time .
The initial work that focused on the 30-day CMS readmission rate was highly dependent on people and process and yielded good results in the overall reduction of the readmissions for the population. Analytics also played a role in providing the compass for sustainment and response to changes in the process. This is noted to be per care discovery data , which later transitioned into EBCC data. The EBCC data for 2016/2017 readmission rates ran in the 20% range.
The DivePort database automatically calculates and generates the CMS 30-day readmission rate. The system uses the following formula in the calculation:
Numerator: Index accounts with a heart failure readmission X 100
Denominator: Index accounts **
** Index Admissions Included in the Measure
An index admission is the hospitalization to which the readmission outcome is attributed and includes admissions for patients:
Index Admissions Excluded from the Measure
Case Study: Optimization Of Heart Failure Therapy With An Sglt
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: Excellent. Thank you for that. Like I said, we have a lot of different tools in our toolbox. Its always nice to understand and help our primary care colleagues. They have a lot on their plate. They have a lot that they need to do within a 15-, 20-, 30-minute visit, and its also nice to be able to share some of these best practices in clinical pearls as they sort through some of their options and as they talk to their patients.
Id love to talk about a real-life case and how were using some of this hot-off-the-presses, so to speak, information, and how were incorporating that into practice. We have a patient case. This is a 64-year-old woman with a history of hypertension, peripheral artery disease, and chronic kidney disease, that is newly hospitalized for heart failure. Dr. Vaduganathan, if you could walk us through your approach and what you were thinking as you saw this patient.
Transcript edited for clarity.
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Heart Failure A Case Study
HMD 570 Summer 2014 Final Project Presented by Angela Wolfenberger Heart FailureA Case Study
Heart Failure Introduction Definition, Etiology, and Diagnosis Symptoms Risk Factors and Public Health Implications Complicating Factors Nutritional Significances Treatment Algorithm
Heart Failure: Definition Heart Failure is a chronic, progressive, clinical syndrome wherein the pumping action of the heart is insufficient to meet the metabolic demands of the body. The heart muscle enlarges, stiffens, and weakens, resulting in inefficient filling and pumping. Blood flow is reduced, causing Insufficient perfusion of organs and extremities. Congestive Heart Failure is a type of HF with pulmonary and peripheral edema. CHF and HF are often used interchangeably.
Heart Failure: Definition, contd 2 Types of Heart Failure: Diastolic- The heart cannot fill properly during the rest period preserved Ejection Fraction Systolic- The weakened ventricle cannot squeeze hard enough to pump fluid properly Decreased EF Heart Failure generally results in: Cardiomegaly Increased Heart Rate Vasoconstriction as the body attempts to compensatefor the weakened heart tissue
Heart Failure: Symptoms What are the Symptoms of HF? Dyspnea , especially when supine Edema Fatigue Cough Nausea, anorexia Syncope Sudden weight gain Angina Elevated heart rate and/or blood pressure Anxiety, confusion, decreased alertness Nocturia
Clinical Transformation Enabled Through Information And Technology
Homestead Hospital has spent nearly a decade working to better manage the heart failure patient population. The people, process and technology approach has evolved over time into a solid transformational process geared toward high performance outcomes. In 2011 as HH faced a 30-day readmission rate of 33.3%, the MCVI Best Practice Committee began to instill educational based processes to lower the readmission rate.
From 2011 to 2014, the following heart failure initiatives were implemented:
- Core measure nurse
- Daily notification of all patients locations by PI department
- Patient education book
- Symptom magnets for home use
- Discharge call back nurse
- Follow up care referrals home health, PCP and when appropriate palliative care
- Interdisciplinary Patient Education Records chart audits
- A dedicated nurse patient educator
The people and process changes led to an improvement in the 30-day readmission rate to 18.18% in late 2014. In 2016, the implementation of the new EHR on a scalable platform created a foundation for continued growth and outcome improvements. The addition of device integration and population health platforms brought BHSF full circle in the capabilities to offer advanced technologies such as clinical decision support alerts, predictive algorithms, automated order sets, care plans, real-time device integration and population health tools such as registries and telehealth .
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Congestive Heart Failure Case Presentation
Initial Actions And Primary Survey
Similar to other patients in the Emergecny Department initial actions include establishing IV access,provding supplimental O2 as needed, and vital sign monitor. These patients may require ECG and CXR
If 100% O2 by non-rebreather fails to increase O2 saturation to at least 95%, noninvasive oxygenation/ventilation such as CPAP or BiPAP may assist in correcting hypoxia. If there is a failure to improve oxygenation, if the patient cannot tolerate the mask, or has a decline in mental status such that they are unable to protect their airway, then endotracheal intubation is required. The use of NIPPV used early can improve work of breathing as well as oxygenation, however caution should be taken as increased intra-thoracic pressure can reduce preload and worsen hypotension.
Hypotension can be difficult to manage in this patient population secondary to existing fluid overload. Early vasopressor support may be needed. Frequently patients with CHF exacerbation with present with significant hypertension. Nitroglycerin can be a useful medication in helping to reduce preload and reduce progression of pulmonary edema.
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Heart Failure Case Study
When it comes to Heart Failure the best form for a brighter future is to optimise the intervention with treatment goals that are vital for the patients health, well-being and gain a better chance of longevity.
The benefits of obtaining a compatible medication treatment goal for the patient, is so to reduce the stress and anxiety for the patient, which in turn can minimise hospital admissions.
Anyone that has other cardiovascular risks such as diabetes, smoking, excessive alcohol and elevated blood cholesterol levels.
The following case study was given freely from a neighbour on his present health.
I have changed his name to protect his confidentiality.
Case study:
Mr Lloyd is a 73 years old widower and has heart failure in the form of Atrial Fibrillation.
He started to become breathless after riding his bike that he did daily. He said that he also noticed excitable flutters in his chest, but did not take much notice as he thought it was because he had over exerted on an activity at his time of life and put it down to the aging process.
He popped to his local General Practitioner with his experiences and was put on a low dose of Warfarin. After a couple of weeks he returned and told his General Practitioner that he was not feeling any better and did not feel right. His General Practitioner told him to continue his dosage for another week.
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History:
Case Report: Congestive Heart Failure
Pharmacy Times Health Systems Edition
The patient’s heart failure needs to be classified to determine the appropriate treatment strategy.
CasePresentation
WC is a 67-year-old man with hypertension, hyperlipidemia, and coronary artery disease, and had triple bypass surgery 17 years ago. His current home medications include amlodipine 10 mg once daily, atorvastatin 80 mg once daily, and aspirin 81 mg once daily. He presents to the clinic with shortness of breath , which occurs when performing simple tasks such as sweeping the floor. He reports sleeping in a recliner at night due to orthopnea. Physical examination reveals elevated jugular venous pressure and 1+ pitting lower extremity edema . An echocardiogram demonstrates systolic dysfunction, mild mitral regurgitation, a dilated left atrium, and an ejection fraction of 30%. Laboratory results show a pro-B-type natriuretic peptide level of 1302 pg/mL, a troponin level of < 0.34, and an unremarkable basic metabolic panel . Measurement of vital signs shows blood pressure of 156/92 mm Hg, a heart rate of 80 beats/min, an Spo2 of 94%, a temperature of 36.5 °C, a pain level of 2 on a scale of 10, and a weight of 185 lb . WCs pharmacy coverage is Medicare Part D. The medical team would like assistance in optimizing the medication regimen for WCs new diagnosis.
Discussion
References
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Case Study On A Patient With Heart Failure
Info: 4157 words Nursing Essay 13th Feb 2020
Mr. SB, 60-year-old male is a retiree and was admitted to the hospital accompanied by his daughter. He is 100kg at a height of 180cm so his calculated body mass index was 30.9 indicating that he was overweight. When admitted, patient was complained of shortness of breath for 2 weeks and was worsening on the day of admission. Besides, he also experienced orthopnea, fatigue, paroxysmal nocturnal dyspnea and leg swelling up to his thigh. Mr. SB was admitted to the hospital for to the same problem last year.
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Mr. SB had known case of heart failure since 3 years ago and he had also diagnosed with hypertension for 5 years. Before admitted to the hospital, patient was taking frusemide 40mg, aspirin 150mg, metoprolol 50mg, amlodipine 10mg, and simvastatin 40mg for his hypertension and heart failure. Patient does not allergic to any medication and he does not take any traditional medicines at home. His family history revealed that his father had died of ischemic heart disease 4 years ago while his brother has hypertension. As for his social history, he smokes 2-3 cigarettes a day for 35 years and the calculated smoking pack years was 5 pack years. Besides, Mr. SB also drinks occasionally.
Therapeutic Aspects Of Heart Failure Management
The outlook for patients with cardiac failure has improved substantially in the last 15 years. This is largely due to the application of the results of multicentre clinical trials of new and older drugs and a better understanding of outcomes for individual patients. Interest has focused on systolic dysfunction in both symptomatic and asymptomatic patients. Less is known about the definition and management of diastolic dysfunction.
The following case studies have been chosen to illustrate the basis for therapeutic management of systolic heart failure and outline the remaining gaps in knowledge, of which there are several. The issues apply across the spectrum of patients seen in clinical practice.
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Education Through Clinical Cases
Presented by the Heart Failure Association of the ESC.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
Management of heart failure is complex. The range of treatments involves drugs, devices, and surgery. The pattern of care by clinical care settings is also diverse and recent advances in diagnosis, treatment and risk stratification further increase the complexity of the heart failure management.
HF specialists are working in a multidisciplinary environment and very often they should make medical decisions by cooperation with other medical specialists.
Education by clinical cases will offer a modern learning tool, very close to real-life clinical practice, aimed to provide knowledge, skills and behaviour required for best clinical practice.
It will allow clinicians to replicate successful treatments in their own practices or get inspired by them.
We are inviting you to share your cases and so to contribute to the education of your colleagues.
Will you meet the challenge?
See more about HFA and discover membership benefits
Improving Adherence To The Standard Of Care
Measure of Effectiveness: The DivePort database automatically calculates and generates the PowerPlan compliance rate. The system uses the following formula in the calculation:
Numerator: Heart failure PowerPlan compliance
Denominator: Index accounts with a heart failure readmission
The PowerPlan was implemented in August of 2018 with a compliance rate of ~26% and an organizational goal of 30%. By May of 2019, the compliance rate was consistently greater than the organizational goal of 30% and HH has sustained compliance of greater than 30% with peak performance of 63% in November 2019. There is slight decrease down to 44% in January 2020 just as the COVID-19 pandemic began to impact healthcare organizations worldwide . BHSF benchmarks against CMS and Premier. Data abstraction methodology is based on claims data, registry data and chart abstraction.
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