A Collaborative Approach for Aggressive Treatment of Heart Failure in all Phases of an ED Visit

2.50
Hdl Handle:
http://hdl.handle.net/10755/162990
Type:
Presentation
Title:
A Collaborative Approach for Aggressive Treatment of Heart Failure in all Phases of an ED Visit
Abstract:
A Collaborative Approach for Aggressive Treatment of Heart Failure in all Phases of an ED Visit
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Legenza, Diane, BSN, RN
P.I. Institution Name:Cleveland Clinic Foundation
Title:Assistant Nurse Manager
Clinical Decision Unit
Contact Address:9500 Euclid Avenue, Mail Code E 19, Cleveland, OH, 44195, USA
Co-Authors:Pat Mahone, BSN, RN; Colleen Danilovic, BSN, RN
Clinical Topic: Data from 1997 revealed that heart failure (HF) return visits were 90% (n = 154) within 90 days after discharge in this emergency department (ED). Of those, 77% required inpatient hospitalization. Medication and dietary noncompliance related to lack of financial resources and insufficient patient knowledge were noted as causes of complications that led to HF exacerbation. The purpose of this project was to develop and implement guidelines for the care of patients with heart failure to decrease ED length of stay, hospital length of stay, and hospital readmission rates. Implementation: A multidisciplinary team established guidelines and designed a protocol and standing orders for care of patients with suspected heart failure or a history of heart failure. The process began in triage. Once the patient met the criteria for heart failure, the treatment guidelines were implemented. These guidelines consisted of a bedside B-Type Natriuretic Peptide (BNP) Level Point of Care Testing (POCT) and initiation of a specific HF protocol with admission orders to a 23-hour observation unit known as the Clinical Decision Unit (CDU). These orders included medications, labs, serial electrocardiograms (ECGs), and notification of the heart-failure team of physicians. Part of this protocol involved early aggressive diuresis. In addition, intensive patient education was offered by nurses and included written and visual materials combined with bedside teaching for patients and families. Referral to other disciplines, such as nutrition therapy and social services, ensured seamless continuity of care. Outcomes: From May 2002 to May 2003, 409 patients were admitted to the CDU with a diagnosis of heart failure. Of these patients, 70% were discharged home with a length of stay less than 24 hours. Return visits to the emergency department were 51% within 90 days after discharge. Recommendations: We recommend implementing guidelines in the emergency department for rapid identification and aggressive treatment of heart-failure patients through a collaborative approach, which can lead to decreased return visits to the emergency department, diminished hospital and ED length of stay, and reduced inpatient hospitalization rates. Other potential benefits include improved patient care, increased staff and patient satisfaction, and better utilization of resources.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA Collaborative Approach for Aggressive Treatment of Heart Failure in all Phases of an ED Visiten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162990-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Collaborative Approach for Aggressive Treatment of Heart Failure in all Phases of an ED Visit</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Legenza, Diane, BSN, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Cleveland Clinic Foundation</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Nurse Manager<br/>Clinical Decision Unit<br/></td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9500 Euclid Avenue, Mail Code E 19, Cleveland, OH, 44195, USA</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Pat Mahone, BSN, RN; Colleen Danilovic, BSN, RN<br/></td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: Data from 1997 revealed that heart failure (HF) return visits were 90% (n = 154) within 90 days after discharge in this emergency department (ED). Of those, 77% required inpatient hospitalization. Medication and dietary noncompliance related to lack of financial resources and insufficient patient knowledge were noted as causes of complications that led to HF exacerbation. The purpose of this project was to develop and implement guidelines for the care of patients with heart failure to decrease ED length of stay, hospital length of stay, and hospital readmission rates. Implementation: A multidisciplinary team established guidelines and designed a protocol and standing orders for care of patients with suspected heart failure or a history of heart failure. The process began in triage. Once the patient met the criteria for heart failure, the treatment guidelines were implemented. These guidelines consisted of a bedside B-Type Natriuretic Peptide (BNP) Level Point of Care Testing (POCT) and initiation of a specific HF protocol with admission orders to a 23-hour observation unit known as the Clinical Decision Unit (CDU). These orders included medications, labs, serial electrocardiograms (ECGs), and notification of the heart-failure team of physicians. Part of this protocol involved early aggressive diuresis. In addition, intensive patient education was offered by nurses and included written and visual materials combined with bedside teaching for patients and families. Referral to other disciplines, such as nutrition therapy and social services, ensured seamless continuity of care. Outcomes: From May 2002 to May 2003, 409 patients were admitted to the CDU with a diagnosis of heart failure. Of these patients, 70% were discharged home with a length of stay less than 24 hours. Return visits to the emergency department were 51% within 90 days after discharge. Recommendations: We recommend implementing guidelines in the emergency department for rapid identification and aggressive treatment of heart-failure patients through a collaborative approach, which can lead to decreased return visits to the emergency department, diminished hospital and ED length of stay, and reduced inpatient hospitalization rates. Other potential benefits include improved patient care, increased staff and patient satisfaction, and better utilization of resources.</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:39Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:39Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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