Preemptive Advanced Clinical Management to Decrease 30 Day Readmissions in the Mechanical Circulatory Support Population

Abstract
Background: The mechanical circulatory support (MCS) population consists of patients with advanced heart failure (HF) who receive a mechanical implanted pump to insure adequate blood flow to prolong life regardless if a transplant will be performed (Jessup et al., 2009). Due to the complexities of the devices and required medical therapy, 79% - 82% of patients receiving MCS are readmitted to the hospital during their time on mechanical support and unplanned hospital readmission is associated with increased mortality in this population.
Purpose: The purpose of this project was to provide preemptive advanced clinical management for MCS patients following hospital discharge to decrease the 30-day readmission rate. This management includes intensive telephone follow-up, education and referrals.
Methods: MCS patients discharged between August 15 and October 15, 2014, participated in this IRB-approved performance improvement project. Patients received telephone follow-up calls 24 to 48 hours after discharge and thereafter on day seven, fourteen, twenty-one, and twenty-eight. A standardized question list based on common reasons for readmission guided the telephone follow-up. Data regarding telephone follow-up issues was recorded. Hospital readmission rates were compared to the same time period in 2013.
Results: Three readmissions occurred with eleven patients (27.2%) in the preemptive group versus five readmissions with thirteen patients (38.5%) in the comparative group. In the preemptive group, ten of the eleven patients reported symptoms during their follow up phone calls. Five of the eleven reported shortness of breath, three weight gain, three bleeding, three driveline drainage, one equipment problem, one with visual disturbance and one with an unsteady gait. All patients received education specific to their reported symptoms and symptoms were reported to the Ventricular Assist Device (VAD) coordinators facilitating interdisciplinary collaboration. Although patients in the preemptive group had similar symptoms to the comparative group, none were admitted for heart failure or cardiac symptoms as in the comparative group and were treated in the outpatient setting. Two of the three readmitted patients were for worsening conditions of their original discharge diagnosis. One patient developed a driveline infection not present on the initial admission.
Implications: Preemptive follow-up in this complex, advanced heart failure population was well received by patients and caregivers to promote self-care. Managing heart failure symptoms and device complications with a collaborative interdisciplinary team decreases hospital readmission which has been shown to correlate with increased mortality in this population.