Dr. Jennifer Hunt, clinical instructor in the department of health services management and policy of East Tennessee State University, has published in the Journal of Nursing Care Quality. The article, “Using Lean to Enhance Heart Failure Patient Identification Processes and Increase Core Measure Scores,” discusses redesigning the process for identifying and updating electronic medical records for patients admitted with a heart failure diagnosis.
Ms. Kelli Jo Ouellette, congestive heart failure coordinator for Ballad Health, and Dr. Michelle Reece, alumna of the East Tennessee State University College of Public Health doctoral program in community health and professor of public health at Western Kentucky University, are co-authors.
Heart failure is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction. In May 2001, the Joint Commission announced four initial core measurement areas for hospitals, which included acute myocardial infarction and heart failure. These areas are measured from a set of specifications and are given a core measure score.
Heart failure core measure scores at a local medical center were lower than the national average, and methods for capturing the appropriate documentation on heart failure patients to ensure core measures compliance were not clear. For this study, an interdisciplinary team determined barriers to increasing core measure scores, gathered baseline data, and identified gaps in the existing process. The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a heart failure diagnosis, and developed a patient appointment section before discharge in the electronic medical record.
After the strategy was implemented, there was a decrease in readmissions within 30 days of implementation from 12 percent to 8 percent, and the heart failure core measure compliance score increased from 88 percent to 100 percent. The percentage of heart failure patients not identified during hospitalization decreased from 17 percent to 0 percent. Heart failure patients discharged with a 7-day follow-up appointment increased from 88 percent to 98 percent. Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and core measures were achieved.