Medicare's Hospital Readmission Reduction Program (HRRP), a body that penalizes hospitals financially for high readmission rates, includes heart failure as one of its 20 targeted conditions ( Yancy et al., 2018). It implies that CHF is one of the most dangerous conditions that lead to a high rate of readmission. According to HRRP, approximately 550,000 individuals are diagnosed with heart failure a year, a condition that calls on hospitals to try to provide quality, management for all aspects of this condition to reduce the rate of readmission ( Yancy et al., 2018).
Need Assessment
The quality improvement needs assessment, in this case, target the emergency departments (ED) for the CHF clinical pathway package used in such departments. The aim is to come up with quality management issues that are at the center of promoting an increased rate of CHF patient readmissions. The clinical pathway needs assessment for CHF at the emergency departments to target the following areas. The first is the educational programs of the CHF clinical pathway used at the ED ( Yancy et al., 2018). The section of the assessment target to understand the level of educative interaction between the physician at the Emergency Departments and the CHF patients. The aim is to understand whether the clinical pathway package for the CHF patients includes educational interaction between the patients and physicians after the admission. The second section of the QI needs assessment for the CHF target of the communication between the ED physicians with the cardiologist consultants ( Yancy et al., 2018). The aim is to understand whether the CHF clinical pathway package has any elements of interaction between the ED physicians with cardiologists on the best ways to care for the patients after they leave the hospital. The Last section of the QI assessment for the CHF clinical pathway, in this case, is the follow-programs packages that people use within the ED.
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Addressing the need
According to research by Figueroa et al., 2018) , a high rate of readmission of the CHF patients stems from low-quality management at the ED. It implies that boasting quality at the ED is an excellent path to reducing such readmission. In this sense, redesigning a clinical pathway package for the CHF patients at the ED can be a good step towards addressing readmission of the CHF patients at the ED. In this sense, an excellent program to curb this challenge should include the following elements. The first is proper communication between the physician at the ED and the cardiologists. According to a research by the American Journal of Emergency Medicine as quoted by Figueroa et al., 2018) , "Improved communication between cardiologists and ED physicians through the establishment of an explicit pathway to coordinate the care of heart failure patients may decrease that population's likelihood of admission without increasing ED disposition times."
Another element of the search for a program is proper follow-up activities. According to Shih et al., 2015). Cardiology follow-up appointment a week after discharge is critical for reducing CHF readmission. The follow-up should be after one week. There also should be telephone follow-ups after the admissions. Finally, the program must have a package for patients’ education on how they can manage their condition to reduce the chances of readmission, according to Figueroa et al., 2018) . Training should be provided to the patients before they bare discharged from the ED.
Outcome Evaluation
There are two approaches to evaluating this program. The first is performance assessment or evaluation. It will target the interaction between the physician at the ED and the cardiologists. The result would help understand whether the key feature of the new CHF clinical package, such as communication practices. It will also assess the rate of patients’ readmission to understand the impact of the programs. The next is the patients’ satisfaction evaluation. It is a series of survey questions targeting the patients’ views on how they feel about how physicians at the ED handles them.
References
Figueroa, J. F., Zheng, J., Orav, E. J., Epstein, A. M., &Jha, A. K. (2018). Medicare program associated with narrowing hospital readmission disparities between black and white patients. Health Affairs , 37 (4), 654-661.
Shih, T., Ryan, A. M., Gonzalez, A. A., &Dimick, J. B. (2015). Medicare’s hospital readmission reduction program in surgery may disproportionately affect minority-serving hospitals. Annals of surgery , 261 (6), 1027.
Tim Goodnough, L., Comin ‐ Colet, J., Leal ‐ Noval, S., Ozawa, S., Takere, J., Henry, D., ... &Shander, A. (2017). Management of anemia in patients with congestive heart failure. American journal of hematology , 92 (1), 88-93.
Yancy, C. W., Januzzi, J. L., Allen, L. A., Butler, J., Davis, L. L., Fonarow, G. C., ... &Masoudi, F. A. (2018). 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology , 71 (2), 201-230.
