Outpatient Intravenous Diuretic Therapy and the Effect on Hospital Re-admissions in Patients with Heart Failure

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Outpatient Intravenous Diuretic Therapy and the Effect on Hospital Re-admissions in Patients with Heart Failure

Phelan, Cynthia - Dissertation

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title: Outpatient Intravenous Diuretic Therapy and the Effect on Hospital Re-admissions in Patients with Heart Failure

creator: Phelan, Cynthia

subject: Dissertations, Academic.

description: Problem: Heart Failure (HF) is a progressive disease and continues to be the most frequent reason for re-hospitalization among cardiac patients. Often patients have no alternative except to seek care within an Emergency Department when experiencing signs and symptoms of fluid overload. Objective: The objective of this study was to determine the impact of providing intravenous diuretic therapy in an outpatient setting for patients with symptoms of fluid overload and weight gain on hospital readmissions, patient experience, overall HF hospital length of stay and cost. Design: Quality improvement design with retrospective chart review was used to evaluate the effectiveness of providing intravenous diuretic therapy in an outpatient setting. Setting: Cardiac Direct Access unit (CDAc) is an outpatient setting designed to accommodate patients who require moderate intensity cardiac care including patients who require intravenous diuretic therapy to manage symptoms of fluid overload. The CDAc has outpatient intravenous infusion capability within its observation unit. Participants: Forty five medical records of adult patients who ranged in age from 51 to 93 years with a diagnosis of heart failure and symptoms of fluid overload and received intravenous diuretic therapy in the outpatient setting were reviewed for this study. Outcome and Measures: Data were collected by retrospective review of electronic patient record and included demographic and clinical characteristics, 30 day ED visits and 30 day readmission rates. Patient satisfaction measures were reviewed using available Press Ganey data. Average charge for outpatient IV diuresis was compared to average charge for an HF inpatient admission. Results: Among the 45 patients, the mean age was 76 years. Overall, 60% were male, with an average BMI of 32.7. Eighty nine percent of patients were NYHA Class 3 or 4. Twenty two percent of patients had an ED visit within 30 days and 44.4% of patients had a hospital inpatient readmission within 30 days of the initial infusion visit. Eighteen percent of patients were admitted directly from an outpatient infusion visit to an inpatient bed. The admitted group and the non-admitted group did not differ significantly in age, EF, AHA stage or BMI. However, when hospitalizations were compared over 9 months prior to outpatient infusion start and 9 months post infusion, the admitted group had an average of 2.25 hospitalizations compared to a mean of 1 in the 9 months post infusion (p = .011). Ninety five percent of HF patients receiving care in the CDAc sampled by Press Ganey reported the overall rating of care as good or very good. The average charge for an outpatient visit was $966.00 compared to $27,280 for a HF admission. Conclusions and Relevance: For patients receiving IV diuretic therapy, this study did not demonstrate a reduction in 30 day readmission rates. However, there was a cost-effective decline in the rate of subsequent hospitalizations in a small subgroup. An outpatient, specialized care option such as IV diuresis for patients with heart failure may result in less emergency department utilization and fewer hospitalizations thereby reducing costs.

publisher: Simmons College (Boston, Mass.)

contributor:

date: 2018

type: Text

format: 1 PDF (56 Pages)

identifier: td_np_2018_cp

source:

language: English

relation:

coverage:

rights: Material from the Simmons University Archives collections are made available for study purposes only. For more information, or to request rights to reproduce or reuse any material, contact the University Archives at archives@simmons.edu.

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