Multidisciplinary Assessment to Personalize Length of Stay in Acute Decompensated Heart Failure (OPTIMA II ADHF)

Frank Dusemund, Martin Steiner, Andre Vuilliomenet, Christian Muller, Rita Bossart, Katharina Regez, Ursula Schild, Antoinette Conca, Andreas Huber, Barbara Reutlinger, Beat Muller, Werner C Albrich, Frank Dusemund, Martin Steiner, Andre Vuilliomenet, Christian Muller, Rita Bossart, Katharina Regez, Ursula Schild, Antoinette Conca, Andreas Huber, Barbara Reutlinger, Beat Muller, Werner C Albrich

Abstract

Background: Acute decompensated heart failure (ADHF) causes a substantial burden for health care systems. Data to rationally define the need for hospitalization or the appropriate length of stay (LOS) is limited. Our aim was to personalize length of stay in patients admitted to hospital for acute decompensated heart failure.

Methods: Consecutive patients with ADHF presenting to our emergency department were prospectively followed. We daily conducted a multidisciplinary risk assessment and compared proposed with actually observed triage decisions.

Results: At presentation, all patients required hospitalization. Median LOS was 11 days including 1 day after reaching medical stability. In 42.7% of patients, hospitalization was prolonged after medical stability mainly for nursing and organizational reasons. Within 30 days of enrollment, 7 (9.3%) patients were rehospitalized, 3 of them for persisting or relapsing heart failure.

Conclusions: There appears to be potential to shorten inhospital stay in patients with ADHF mainly by providing post discharge ambulatory nursing care in order to improve resource utilization and to diminish "hospitalization-associated disability".

Keywords: Acute decompensated heart failure; Biopsychosocial assessment; Hospital-associated disability; Length of stay; Triage process.

Figures

Figure 1
Figure 1
Virtual triage algorithm. PACD: post acute care discharge score; SPI: “Selbstpflegeindex”. At all time points of risk assessment, medical risk has been evaluated first. In case of medical stability, biopsychosocial and functional risk (“2.”) was determined: if then the PACD-score (“2a”) was below 8 points, SPI was calculated (“2b”). Then, the virtual preferred site of care (according to the arrows) was explained to the patient, who could deny beeing discharged.

References

    1. U.S. Department of Health and Human Services, Health Care Finance Organization . MEDPAR Inpatient Hospital Datafile, Fiscal Year 1998. Washington DC: Bureau of Data Management and Strategy: 1999: June Update
    1. American Heart Association . Heart disease and stroke statistics 2004 update. Dallas TX: American Heart Association; 2004
    1. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". JAMA. 2011;306(16):1782–1793.
    1. Albrich WC, Ruegger K, Dusemund F, Bossart R, Regez K, Schild U, Conca A. et al. Optimised patient transfer using an innovative multidisciplinary assessment in Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections. Swiss Med Wkly. 2011;141:w13237.
    1. Logeart D, Thabut G, Jourdain P, Chavelas C, Beyne P, Beauvais F, Bouvier E. et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol. 2004;43(4):635–641.
    1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–1847.
    1. Heart Failure Society Of A. Evaluation and management of patients with acute decompensated heart failure. J Card Fail. 2006;12(1):e86–e103.
    1. Bettencourt P, Azevedo A, Pimenta J, Frioes F, Ferreira S, Ferreira A. N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation. 2004;110(15):2168–2174.
    1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF. et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27–72.
    1. Louis Simonet M, Kossovsky MP, Chopard P, Sigaud P, Perneger TV, Gaspoz JM. A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility. BMC Health Serv Res. 2008;8:154.
    1. Grobe Schlarmann J: Der CMS im ePA. Verschiedene Qualitatsdimensionen eines Instruments. Eine empirische Analyse. Gelsenkirchen: Private Universitat Witten/Herdecke gGmbH. 2007
    1. Noveanu M, Breidthardt T, Potocki M, Reichlin T, Twerenbold R, Uthoff H, Socrates T. et al. Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure. Crit Care. 2011;15(1):R1.
    1. Kossovsky MP, Sarasin FP, Chopard P, Louis-Simonet M, Sigaud P, Perneger TV, Gaspoz JM. Relationship between hospital length of stay and quality of care in patients with congestive heart failure. Qual Saf Health Care. 2002;11(3):219–223.
    1. Suter TM, Wirthner A, Kuhne R. Disease Management als Prozessinnovation - zukunftsfähig auch in der Schweiz? Managed Care. 2002:15–18.
    1. Harjola VP, Follath F, Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Hochadel M. et al. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail. 2010;12(3):239–248.
    1. Tibaldi V, Isaia G, Scarafiotti C, Gariglio F, Zanocchi M, Bo M, Bergerone S. et al. Hospital at home for elderly patients with acute decompensation of chronic heart failure: a prospective randomized controlled trial. Arch Intern Med. 2009;169(17):1569–1575.
    1. Venskutonyte L, Molyte I, Ablonskyte-Dudoniene R, Mizariene V, Kavoliuniene A. Characteristics and management of acute heart failure patients in a single university hospital center. Medicina (Kaunas) 2009;45(11):855–870.
    1. Adams KF, Jr., Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL. et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE) Am Heart J. 2005;149(2):209–216.
    1. Bueno H, Ross JS, Wang Y, Chen J, Vidan MT, Normand SL, Curtis JP. et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA. 2010;303(21):2141–2147.
    1. Aziz EF, Alviar CL, Herzog E, Cordova JP, Bastawrose JH, Pamidimukala CK, Tojino A. et al. Continuous infusion of furosemide combined with low-dose dopamine compared to intermittent boluses in acutely decompensated heart failure is less nephrotoxic and carries a lower readmission at thirty days. Hellenic J Cardiol. 2011;52(3):227–235.
    1. Chen J, Normand SL, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008. JAMA. 2011;306(15):1669–1678.
    1. De Geest S, Moons P, Callens B, Gut C, Lindpaintner L, Spirig R. Introducing Advanced Practice Nurses / Nurse Practitioners in health care systems: a framework for reflection and analysis. Swiss Med Wkly. 2008;138(43-44):621–628.
    1. Schadewaldt V, Schultz T. Nurse-led clinics as an effective service for cardiac patients: results from a systematic review. Int J Evid Based Healthc. 2011;9(3):199–214.
    1. Balaban RB, Weissman JS, Samuel PA, Woolhandler S. Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study. J Gen Intern Med. 2008;23(8):1228–1233.

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