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简介：Itisestimatedthatmorethanonemillionheartfailurehospitalizationsoccureachyear.Systolicheartfailureandheartfailurewithpreservedejectionfractioncontributeequallytoheartfailurehospitalizations.Heartfailurereadmissionratescontinuetobeabout25%.Strategiestoreduceheartfailurereadmissionarekeytoreducinghospitalizationrates.Thestrategiestoreduceheartfailurehospitalizationareasfollows:(1)Duringhospitalization,diuresistotheeuvolemicstateisessential.Fiftypercentofdischargedheartfailurepatientshaveminimalweightlossduringthehospitalization,representingminimaldiuresis,butstillfluidoverload.(2)Duringhospitalization,interrogatethedefibrillatororbiventricularpacemaker(ifapplicable)toensurethatthereisnorightventricularpacingandthereisappropriatebiventricularpacing.Interrogationofdevicescanidentifyarrhythmiaorsuboptimalbiventricularpacing,whichcancontributetodecompensation.(3)Beforedischarge,identifythereasonfordecompensation,suchasatrialfibrillation,infection,pulmonaryembolism,ornoncompliance.(4)Beforedischargeamultidisciplinaryteamisneededtoeducatethepatientondiet,medications,fluidweightsurveillance,andexercise.(5)Apostdischargevisitshouldoccurwithin10daysandwithemphasisonuptitrationofneurohormonalblockersandcontinuedcongestionmanagement.Suchinterventionsconductedbyamultidisciplinaryteamhavethepotentialtoreduceheartfailurehospitalizationrates.

简介：AbstractObjective:Unplanned 30-day readmissions result in increased costs and decreased patient satisfaction. The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focused on patient and staff education, use of targeted skilled nursing facilities, and appropriate use of patient observation status.Methods:This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3-year period between October 2015 and September 2018. In October 2016, the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery. These changes included enhancing patient education, increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses, and appropriate utilization of 23-h observation status for returning patients. The readmission rate from the pre-intervention era (October 2015 through September 2016) was compared to the readmission rate from the post-intervention era (October 2016 through September 2018). Secondary outcomes were the rates of 23-h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge.Results:In this sample of 449 patients, 161 (35.9%) were observed before the change-in-practice (before October 2016), and 288 (64.1%) were observed following the change-in-practice (after September 2016). On univariable analysis, the risk of readmission declined by approximately 41.4% from the pre-intervention era, though this conclusion was not statistically significant (P= 0.06). On multivariable analysis, patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days (P = 0.03). Similarly, those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days (P= 0.001). No patient characteristics were associated with a 23-h observation following discharge (all P > 0.05). Conclusions were similar for emergency room visits following discharge.Conclusions:A three-part quality improvement strategy resulted in a clinically important decrease in 30-day readmissions, though the decline was not statistically significant. There were no significant changes in 23-h observation within 30 days of discharge or emergency room visits within 30 days of discharge.