Establishing a Nurse-Run Clinic for Heart Failure Patients – University of Mississippi Medical Center (UMC); Jackson, Miss.
Reduce readmissions and return visits to hospital emergency departments (ED) among heart failure patients.
An off-site, nurse-led heart failure clinic was created to help heart failure patients better control and self-manage their disease post-hospitalization.
Approximately one year after the clinic opened its doors, about 50 percent of its heart failure patients had not had a repeat ED visit. Before it opened, many were visiting the ED on a regular basis.
University of Mississippi Medical Center2500 N. State StreetJackson, MS 39216P: (601) 984-1000
From the C-Suite:
"From all indications, the clinic is helping our patients better self-manage their heart disease and better transition from the hospital to the ambulatory setting so that they don't need to return to the emergency department or be readmitted. For the hospital and our patients, this signifies better patient outcomes and lower health care costs."
Michael Winniford, M.D.Medical Director of Cardiovascular Services, University of Mississippi Medical Center; Professor and Vice Chair, Department of Medicine and Surgery
University of Mississippi Medical Center is a 722-bed academic facility and is the state's main diagnostic and referral center.
Clinical areas affected:
- Nurse practitioner specializing in heart failure
- Clinic R.N.
Nine months from initial planning (August 2006) to clinic's opening (May 2007)
Patricia Hughes, R.N.Clinical Outcomes Coordinatorpfhughes@medicine.umsmed.eduP: (601) 815-8597
Heart failure is the No. 1 reason for hospitalization among adults in Mississippi, largely because they are neither receiving the care they need in an ambulatory or outpatient setting nor managing their disease with diet, exercise and lifestyle changes.
To address this challenge, a team at UMC decided to create an off-site, hospital-funded and nurse practitioner-led heart failure clinic located a couple of miles from the hospital. At hospital discharge, Medical Center cardiology patients with Stage B or C heart failure and/or with an ejection fraction of less than 40 percent are frequently scheduled for follow-up appointments at the clinic in an effort to reduce their future ED visits and readmissions.
During the patients' clinic visits, a nurse practitioner gives them an exam but more time is spent counseling the patients on lifestyle changes. Together, the clinic nurse and patient discuss exercise habits, dietary recommendations, coordination of care with other health care providers and tips for home self-care. All patients also meet with a pharmacist to discuss their medication routine and ensure they have the means to obtain and afford their prescribed medications. Patient outcomes and quality indicators are closely monitored and tracked via data management, most of it online.
Advice and lessons learned:
1. Engage a cardiologist to be the clinic's champion.
2. Secure adequate staff and clinic space before beginning.
3. Allow money for materials.
Medical literature documents and clinic visits are considerably less expensive than ED visits. Approximately half of UMC cardiology patients have not had an ED visit since the clinic opened. The team is currently reviewing six-month readmission rates, but expects to have more concrete, reliable rates once the clinic has been open for a year.