Implementation and Evaluation of an Inpatient CHF Quality Indicator Electronic Medical Record Checklist and Alert System

Abstract

Problem Statement: Over six million Americans have a heart failure diagnosis and are likely to be hospitalized, with each admission costing between $14,000 and $30,000. At Peninsula Regional Medical Center (PRMC), 19% of all patients admitted in 2018 with heart failure exacerbation were readmitted to the hospital with another event within 30 days of discharge. For the Peninsula Inpatient Providers, this number was even higher at a 20% readmission rate. Purpose: To implement Basoor’s Discharge Checklist within the EMR to improve hospitalist providers adherence to discharge clinical guidelines for medication usage, education, and follow-up services for heart failure patients and reduce 30-day readmission rates. Methods: A quasi-experimental pre-post design was used to compare provider adherence with clinical guidelines for ACEI/ARB prescription at discharge, 2-D echocardiogram completion during a hospital stay, and cardiology appointments made prior to hospital discharge before and after implementation of an evidence-based heart failure checklist and alert system within the EMR. Results: Of the 193 patients meeting eligibility criteria during the 2-month implementation period, providers used the Basoor Discharge Checklist in some form for 15% (n = 29). A chi-square test of independence confirmed a relationship between the prescription of ACEI/ARB medications at discharge and utilization of the Basoor Discharge Checklist (χ2(4) = 9.82, p = .044). Significance: Implementation of the checklist over a two-month time period demonstrated increased rates of ACEI/ARB prescription at discharge. Additional research is necessary to determine impacts on 2-D echocardiogram completion, cardiology appointments, and 30-day readmission rates.