Heart Failure Self-Management Education: Does Timing Have an Impact on Readmission Rates?

Hospital readmissions are expensive but relatively common among heart failure (HF) patients. Studies have found that teaching patients self-management strategies to use at home, including early reporting of symptoms, can help to prevent hospital readmissions. Therefore, identifying and implementing critical elements of efficacious self-management education can impact readmission rates. The acute cardiovascular unit at a large medical center in Salt Lake City has recently implemented a new protocol for HF patients. This new protocol includes initiating selfmanagement education on day one of hospital admission and continues with reinforcement throughout the patient's stay. Previously, this education was provided randomly or at discharge. The intention of the new protocol is to improve patient understanding and compliance with selfmanagement strategies that should, in turn, reduce exacerbations and allow for treatment in an outpatient setting. However, it is unclear as to whether this protocol was having any significant effect on hospital readmission rates. The purpose of this project was to evaluate the impact of timing of self-management teaching on hospital readmission rates. The specific objectives of this scholarly project were to: • Perform retrospective chart review of documented self-management teaching. • Determine if there is a relationship between timing of the education and 30-day readmission rates. • Present findings to stakeholders. Reasoning for this project was based on research that demonstrated adequate selfmanagement education to be a key piece of HF readmission prevention, particularly when patients are able to in self-management skills. While an assumption can be made that the earlier this education begins, the better the patient will understand and master these skills, there is a dearth of literature addressing whether the timing of the education truly has any impact. This project helped to fill the gap. A retrospective chart review was undertaken to determine the effects of education timing on readmission rates. Based on the survival analysis conducted, HF patients who experienced a delay in MAWDS education were at a higher risk for readmission during the 30-day postdischarge period. This has significant implications both in terms of HF patient morbidity as well as CMS reimbursement. These findings suggest that dedicating resources to early MAWDS education improves outcomes among patients and also may reduce the financial burden of hospital readmissions. The findings of this analysis were disseminated through a stakeholder briefing and submission of a scholarly poster to a Utah Nurse Practitioners conference meeting. Evidence for proven strategies to reduce HF readmission rates is limited. The proposed project helped to determine whether providing patient education early in the hospital stay can impact readmissions. This contributes to the body of literature identifying best practices for HF care and helps to inform the judicious use of healthcare resources.