The Health Roundtable Hospital 2 Home – Heart Failure Pathway, Reducing Readmissions Presenter: Dr Stephen Jennison Whangarei NZ Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012

The Health Roundtable KEY PROBLEM Background Whangarei Hospital readmission data –  Heart failure and shock readmission rate is 27.3%  This group of DRGs had 144 readmissions in the 2010/11 year, which cost the DHB $510,000 and consumed 460 patient bed days  Respiratory conditions readmission rate of 19.4%  209 readmissions in the 2010/11 year  ALOS for these readmissions was 4.45 days (930 bed days total), and cost to the hospital $872,000  90% of the patients readmitted lived within 30 minutes from the hospital

The Health Roundtable AIM OF THIS INNOVATION Improvement Sought  Reduce readmission rates for heart failure by 20%.  Develop a patient focused, centred care approach with the development of a Heart Failure Pathway that commences in the Emergency Department, and finishes with the transfer of patient care back to the GP.

The Health Roundtable BASELINE DATA The Issue  Overall, the current rate of NDHB all acute readmissions uses up considerable resource, i.e. total of 2,955 bed days over the 2010/11 year. This equates to 8 beds every day of the year, at an annual cost of $3.6m.  Reduction in readmission rates of 30 days or less (MoH target). NDHB currently has an overall readmission rate of 10.25%; an organisational driver, as well as an MoH driver, is to reduce this readmission rate to 9.95% for the FY 2011/12.  Areas of high readmissions are Cardiology and Respiratory patients, whose rates have been identified as being higher than we want, and the rates of readmission have significantly increased over the last 2 years.  Reduction in ED admissions is another key driver. The increase in ED presentations continue; several programmes are underway to attempt to reduce these presentations. The increasing volume plays a significant role in ED overload and evidence shows this increases patient mortality and morbidity.

The Health Roundtable KEY CHANGES IMPLEMENTED dd

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The Health Roundtable LESSONS LEARNED What would you recommend to other organisations?  Start HF pathway ASAP: preferably in the E.D.  The peak time for readmission is within 10 days of discharge.  Involvement of the hospital and community pharmacist is key.  The H2H visit is an excellent time to reinforce hospital educational initiatives.  Be clear about the scope