Owatonna Hospital/Owatonna Clinic - Owatonna, Minnesota

Congestive Heart Failure Initiative

Overview: Owatonna Hospital is a 77-licensed bed, non-profit hospital providing care to patients in and around Steele County, Minn.  It is part of Allina Hospitals & Clinics, a not-for-profit network of hospitals, clinics, and other health care services, providing care throughout Minnesota and western Wisconsin.  Owatonna Clinic is a comprehensive medical clinic offering outpatient and specialty services.  It is part of Mayo Health System, a family of clinics, hospitals and health care facilities serving 70 communities in Minnesota, Iowa and Wisconsin.

Beginning in mid-2006, Owatonna Hospital and Owatonna Clinic clinical teams began collaborating to examine admission and readmission rates for patients with congestive heart failure-the most common reason for admission.  Their purpose was to identify ways to reduce admission/readmission rates for both inpatients and outpatients.  By January 2007, after meeting with nurse practitioners and care managers, they determined that they needed to maximize the link between continuity of care and the education patients received at discharge.

In April 2007, Owatonna Hospital and Owatonna Clinic developed the Congestive Heart Failure Initiative, a four-step initiative to increase optimal care of congestive heart failure patients to 100% by December 31, 2007.  Specifically, the goal was to reduce readmission rates and decrease overall treatment costs.  New treatment methods provide inpatient and outpatient treatment and education to help chronic heart failure patients live longer, more rewarding lives. The four steps, outlined below, involve improved treatment documentation in patient charts, enhanced education while the patient is in the hospital, and improved discharge instructions that include referring heart-failure patients to the clinic for further outpatient monitoring, education, and dietary counseling.

Four-step process
First step: Access health care

Diagnosis, evaluation, and implementation of evidence-based guidelines

  • Documentation of ECHO results, appropriate use of ACEI/ARB unless contraindicated
  • Education regarding smoking cessation
  • Discharge instructions including diet, activity, medication, weight monitoring, reporting symptoms, follow-up (preprinted orders upon admission)

Second step: Education during hospitalization
Day 1

  • Understanding how the heart works
  • Understanding heart failure
  • Identifying causes of heart failure
  • Symptoms of heart failure

Day 2

  • Understanding ECHO, EDG, lab, stress test, and meaning of results
  • How to manage your heart failure
  • When to call the health care provider or 9-1-1
  • Nutrition education for a healthy heart

Day 3

  • What you need to know about your medications
  • Medicine do's and don'ts
  • Review of medications

Third step: Discharge planning
Referral to Heart Failure Clinic

  • Order set for heart failure includes an order for a referral to the Heart Failure Clinic, with appointments advised for three to five days after discharge. Patient's primary care physician is included as part of process.

Fourth step: Heart Failure Clinic at Owatonna Clinic

  • Review most recent ECHO results, determining diastolic vs. systolic
  • Continue to educate patient and family on heart failure diagnosis; disease management process to include:
    • Sodium intake
    • Reading labels
    • Fluid intake
    • Monitoring of daily weight
    • Building action plan: when to seek help before hospitalization
  • Use aggressive medicine titration for maximum effectiveness
  • Monitor lab work
  • Manage symptoms
  • Provide emotional support to patients and families

Impact: The national average for 30-day readmission rates for congestive heart failure is 18%-22%.  In 2006, Owatonna Hospital's readmission rate was 20%; in 2007, it decreased to 15.9%; and in 2008, it was 11.9%.  The initiative has resulted in more effective utilization; reduced admission/readmission rates; more efficient, effective use of staff, time, and resources; better patient experience, and better disease management.  In January 2008, Owatonna Hospital was named the winner of the 2007 "Innovation of the Year in Patient Care Award" by the Minnesota Hospital Association.

Challenges/success factors: In 2006, preprinted orders were not always used when a patient was admitted, meaning that treatment could vary, and referral to the heart failure clinic did not always happen.  In addition, the educational materials given to patients were not consistent between the hospital and the clinic.  Teamwork between the clinic and hospital were key to the success of this initiative.  They developed standing orders and mapped out coordination of staff from the hospital and the clinic to follow an effective, patient-focused process of diagnosis, treatment, evaluation, and follow-up.  The hospital and clinic now use the same educational pieces; the materials' consistency makes it easier to emphasize the importance compliance to patients.

Future direction/sustainability: Owatonna Hospital and Owatonna Clinic will continue to collaborate and aim higher.  They will continue to be data driven, be tenacious, and celebrate results.  To them, these kinds of initiatives will help to redefine the health care model.

Advice to others: Make sure the patient's primary care physician is part of the process.  This ensures better compliance and keeps all members of the care team in the loop.  In addition, use hard data to gain buy-in from organizational leaders.  Finally, focus on commitment to the patient and to education, making sure the patient understands the disease management process.

Contact: Debra Brase
Marketing and Communications Manager
Telephone: (507) 444-6070
E-mail: debra.brase@allina.com



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