Post-Heart Transplant Education Outpatient Screening and Referral: A Quality Improvement Project

Background: After heart transplant, patients are given an overwhelming amount of information before discharge. Studies show that comprehension among hospitalized patients is poor, and, on average, they immediately forget 40-80% of what they are taught, and surgery can further hinder the learning and processing abilities. Multifaceted approaches should be used to help improve knowledge, and ongoing nurse-led education has been shown to improve self-management and early clinical outcomes in heart transplant patients. Local Problem: Providers at a local transplant center did not provide or have a process for ongoing nurse led education for post heart transplant in the outpatient clinic. Methods: Clinic staff were given matched pre- and post-education surveys, to determine providers' knowledge, interest, and attitudes toward screening post-heart transplant patients for additional nurse-led education in the outpatient clinic. Retrospective chart reviews assessed the usability of the new workflow. Clinicians who used the new workflow process were given a post implementation survey to assess staff satisfaction and the new workflow's usability and feasibility. Interventions: The interventions for this project consisted of creating a new discharge binder, and several one-page handouts highlighting information from the binder. The one-page handouts served as a resource for the nurses providing additional education in the outpatient clinic. A screening tool and hot texts were created for standardizing the screening, referral, and documentation. Results: Twenty-two staff members participated in the pre-presentation survey and nineteen participated in the post-presentation survey. The Wilcoxon Sign Test using matched dates from the pre and post education surveys indicated a statistically significant increase in staff confidence in recognizing transplant patients who could benefit from additional nurse-led education. Staff agreed that a good clear process for screening and referring patients was defined. All staff felt the patients found the education helpful, and were satisfied with the education, workflow, and plan to continue the new process. Conclusions: This project provided a process for providers to screen and refer post-heart transplant patients in the outpatient clinic for additional personalized one on one nurse led education. Providing additional education in the outpatient clinic has the potential to demonstrate long-term implications such as reduced outpatient visits, clinical problems and decrease days until the first unplanned hospitalization.