Forest Hills Hospital takes innovative approach to congestive heart failure, lowering readmission rates and boosting patient satisfaction.

By: Richard Bocklett

The North Shore-LIJ Health System – covering Long Island, Queens, and Manhattan – received the National Quality Forum‘s 2010 Healthcare Award for its high quality, transparent, and client-centered delivery system.

It is the first Healthcare Award recipient in the New York area. The award recognizes the system’s innovative quality care services, which have improved patient outcomes.

Using observed mortality rates minus expected mortality rate statistics, the hospital system calculated it saved 920 lives in 2008, and 1,085 lives last year.

Forest Hills Hospital integrated its quality care with an innovative approach to congestive heart failure (CHS) patients, lowering readmission rates and boosted patient satisfaction.

There’s savings in additional staff and monetary expenditure as well

Based on research indicating that follow-up phone calls to CHF patients might reduce their high recidivism rate shortly after discharge, the Forest Hills Hospital Congestive Heart Failure Task Force initiated once-a-week post-release calls over a six-week period. Readmission rates dropped from 32 percent at inception, in June to 14 percent in December.

Nationwide, 5.7 million people live with chronic, debilitating congestive heart failure, a condition wherein the organ works in an ineffective manner. However, with proper care and management, victims can lead a fuller life and avoid repeated trips to the hospital.

The hospital task force is composed of medical and cardiology directors, managers from nutrition, quality assurance and education disciplines, and ER, Recovery Room and floor nurses.

Their research showed a Recovery Room general nursing down time from 8 a.m. to 9 a.m., and when O.R. procedures are cancelled or rescheduled. During these times, Recovery Room nurses volunteered to place checkup phone calls to recently released congestive heart patients.

Since Recovery Room nurses are already call-back trained with their surgery patients, when provided with CHF procedures and questions, they were a perfect fit for the innovative task.

“They listen with the third ear, pick up signs and symptoms, and are very comfortable dealing with emergency situations and critically ill patients,” said Rita Merieca, the hospital's associate executive director of nursing.

Nurses place 45 to 60 calls each week. Most take between 10 and 20 minutes. The nurses assess the patient’s status and pose questions on weight gain, which could indicate a relapse, ankle swelling, sleep routine, medication compliance and diet maintenance.

“Too much salt, for example, puts them back in the hospital,” Mercieca explained. “So diet makes a big difference.”

The nurses also address common medical problems like patients continuing with their old medicine, which may not be effective, or the tendency to slacking off with medication when they feel better.

Alternatively, although they might not be feeling well, patients sometimes hesitate to visit the doctor. The nurses intercede to see the patients get timely care to avert deterioration.

“The patients really enjoy the calls,” Mercieca said. “One man with multiple admissions reported the hospital care was even beyond his expectations.”

Gerard Brogan, Forest Hills Hospital's medical director, stressed that CHF patients should see a physician within the crucial first week of release, or else they put themselves at high risk for readmission.

“The phone follow-ups reminding them to comply with their release instructions, including weighing themselves daily and having early medical attention helps greatly,” Brogan said.

With the country's growing aging population, CHF has become a public health epidemic, moving to the top of the medical priority list. As a result, “heart failure therapies are changing and evolving and we’re looking deeper into the disease,” Brogan said.

“Heart failure is a perfect example of where basic medicine - watching weight and diet, taking medication and keeping scheduled physical exams - is a very powerful tool that is under-appreciated,” he added.

Left to themselves, physically challenged, elderly CHF patients often get sicker at home before finally calling 911 to be hospitalized.

“The answer is having follow-up care, either in person or at least by telephone by a professional, to help identify patients that might require a visiting nurse or a doctor’s house call to avoid a second hospitalization,” Brogan said.

Under new national health care program standards, Medicare will not reimburse hospitals for congestive heart failure patients who are readmitted within 30 days of discharge if preventable measures weren’t taken.

“Treating congestive heart failure is a quality of service and a cost-saving issue,” said Linda Dasher, the hospital’s assistant executive director for quality management. “Forest Hills Hospital is pro-actively looking into this.”