Closing the Care Gap: A Nurse-Led Heart Failure Clinic to Timely Clinic Review and Reduce Unplanned 30 Days Readmission
Care Process & Redesign
National University Health System Quality Improvement
National University Health System
31 December 2019
Reduce 30-day unplanned readmissions for heart failure reduced ejection fraction (HFrEF) patients. Nurse-led models improve outcomes and are scalable for heart failure management programs.
Year Submitted: 2019
Published Date: 31 December 2019
Tags: Care Process ＆ Redesign, Access To Care, Readmission Rate, Waiting Time
About this Content
Aims
Reduce 30-day unplanned readmissions for heart failure reduced ejection fraction (HFrEF) patients.
Background
78% of heart failure patients were readmitted within 30 days, exceeding hospital targets.
Methods
Implemented nurse-led clinic, offering early reviews, opportunistic vaccinations, and rapid medication optimization.
Results
Reduced readmissions significantly with improved patient engagement and optimized care plans.
Conclusion
Nurse-led models improve outcomes and are scalable for heart failure management programs.
Lessons Learnt
A multi-pronged, holistic approach is key to reducing unplanned readmissions for HFrEF patients.
Additional Information
Included ad hoc clinics for higher-risk patients.
Keywords
Heart Failure, Nurse-Led Clinic, 30-Day Readmission, Early Review, Quality Care
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | Ng Teng Fong General Hospital |
Platform(s) | National University Health System Quality Improvement |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Cardiology |
Project Lead(s) | Lay Cheng Toh |
Project Member(s) | Chan Po Fun |
Connect with this contributor!
Lay Cheng Toh - lay_cheng_toh@nuhs.edu.sg