Implementation of Low-Burden HF Protocol Reduces Hospital Readmissions

A novel heart failure (HF) management protocol implemented at a southwest Virginia skilled nursing facility (SNF) in 2021 dropped the 30-day all-cause hospital readmission rate to under 10% over 10 months, according to a study published in Gerontology and Geriatric Medicine.

“The HF management protocol prioritized (a) reducing hospital readmissions, (b) low-burden delivery by regular SNF staff, (c) incorporation of standing intravenous diuretic orders, and (d) remote dielectric sensing (ReDS) vest readings,” wrote study first author Michelle S Rockwell, PhD, RD, of the Virginia Tech Carilion School of Medicine in Roanoke, VA, and coauthors.

The protocol was administered to 42 patients with a recent hospital discharge and a diagnosis of active HF between January 2021 and November 2021. It consisted of sequential body weight, vital sign, blood, and ReDS vest assessments, as well as standing orders for fluid/sodium restriction and oral and intravenous diuretics.

Among the 42 patients enrolled in the protocol, 2 patients were readmitted to the hospital within 30 days of hospital discharge and 4 patients were readmitted to the hospital within 30 days of SNF discharge, according to the study. 

Compared with 2020 rates of 16.7% for readmissions within 30 days of hospital discharge and 22.2% for readmissions within 30 days of SNF discharge, rates under the protocol fell to 4.8% and 9.5%, respectively, the study showed. The drop in readmission rates reflect a potential savings in hospital costs between $132,418 and $176,573.

“This preliminary evidence suggests that implementation of the HF management protocol has the potential to reduce costs and consequences associated with hospital readmission for SNF patients with HF,” researchers wrote. “Due to the limited controls in place during the present investigation, further research is needed to confirm the HF management protocol’s effectiveness.”

Reference:
Rockwell MS, Cox E, Locklear T, et al Implementation of a multimodal heart failure management protocol in a skilled nursing facility. Gerontol Geriatr Med. Published online February 3, 2023. doi:10.1177/23337214221149274