New Hanover Regional Medical Center and its physician practices receive high volumes of patients with congestive heart failure (CHF). With increasing numbers of patients from a seven-county region and high readmission rates, NHRMC recognized a need to improve the care this complex patient population received.
Beginning in 2015 with a Lean Kaizen event involving representatives from all areas of patient care, NHRMC verified the need to build a CHF program. All subsequent analyses, problem solving, and evaluation for developing the CHF program were conducted using the Lean methodology to ensure that each patient received consistent quality care and access to education, ultimately helping our patients recover better. Through this initiative, the CHF team is helping to fulfill NHRMC’s mission of “leading our community to outstanding health.”
NHRMC set a goal to reduce its overall CHF readmission to below 20% by 2017. To do this, NHRMC implemented five major changes:
- Establish a plan of care for each patient from hospital discharge and continuing through the next six months. This 6-month plan became standard practice at Cape Fear Heart Associates, an NHRMC Physician Group practice.
- Create a patient education booklet and make sure each patient had an individualized education plan
- Provide free CHF patient education classes each month. Four classes are held each month, focusing on general disease overview, nutrition, medications and advanced directives.
- Adopt new technology, the cardioMEMS device, which monitors fluid volume so the CHF team can spot potential problems before symptoms occur.
- Research shows that disease-specific hospital unites lead to better results for patients. Therefore, a team of nurses, a hospitalist, Dr. John Rommel (CHF Medical Director), and CHF Program Manager Rachel Hayworth met to find a way to maximize the number of CHF patients who are admitted to the designated heart failure floor, instead of other hospital floors.
From 2016 to 2017, the readmission rate for CHF patients dropped from 21.2% to 18.6%. The CHF Case Managers’ patient education program is largely to credit for this decrease in readmissions. Of the patients they taught in 2017, only 7% readmitted with a heart failure-related issue.
These numbers show that the CHF program is helping educate patients about how to live healthier with congestive heart failure and is monitoring them closely for potential problems to keep them from making return trips to the hospital.
“The heart failure program is comprised of a very strong team, and we are thrilled to be recognized for our hard work in developing this program,” said Rachel Hayworth CHF Program Manager. “But this is only the beginning! Because we care about the health of everyone in our community, we are excited to build upon this foundation and continue developing a leading CHF program in our state.”
The CHF Program at New Hanover Regional Medical Center earned a Silver Touchstone Award in the Clinical Services category from Atrium Health, which has a services agreement with NHRMC. The Touchstone Award was one of seven earned by NHRMC in 2018.
- Cardiology Medical Director: Dr. John Rommel, Cape Fear Heart Associates
- Congestive Heart Failure (CHF) Program Manager: Rachel Hayworth
- CHF Advanced Care Providers (ACPs): Lauren Gardner, Bridgette Williams, Hanes Mintz, Ellen Klaenhammer
- CHF Program Coordinator: Catherine Garner
- CHF Clinic Nurse: Molly Vanhoy
- CHF Case Managers: Becky Guy, Allison Mills
- Internal Medicine Hospitalist: Dr. Kevin Adgent