Heart failure patients often require close monitoring and intravenous (IV) diuretics to prevent worsening of their condition and hospitalization. In the past, the Infusion Clinic was the only outpatient option for patients to receive this therapy. Unfortunately, due to high utilization of the Infusion Clinic, same-day appointments were not always available to heart failure patients requiring treatment. To increase access to care, nursing leaders set out to create an alternative location for patients to receive timely therapy and to prevent unnecessary delays in receiving the medical therapy needed to manage this significant health condition.
To address this need, a Heart Failure IV Diuretic Clinic in the Center for Advanced Care (CFAC) at Froedtert Hospital was created.
What Does the Clinic Offer?
- Provides same-day access for IV diuretics.
- Provides next-day visits for Emergency Department heart failure patients.
- Can see patients in Cardiology within seven days of discharge.
- Offers patients Lasix and Bumex IV diuretics.
- Accepts referrals from the Enterprise Care Coordination team. Heart failure patients are called within 30 days of discharge to assess fluid overload symptoms and determine if IV diuretics are needed.
- Tracks patients with CardioMEMS™ and OptiVol™ implants bi-weekly for fluid volume status.
Results
- Monthly tracking and reporting of Cardiology Clinic IV diuretics and patient outcomes post IV diuretics at the Quality meeting
- More than 200 IV diuretics were given in the last 12 months, resulting in preventable admissions
- Preventable admissions allowed other patient admissions, resulting in a cost savings of $700,000
- The new model allows patients with frequent readmissions for volume overload weekly or biweekly scheduled infusions of IV diuretics
- Patients being discharged from the hospital with mild residual congestion can be discharged with a shorter length of stay by using the IV diuretic option in the clinic to resolve their congestive heart failure exacerbation
Conclusions
The Heart Failure IV Diuretic Clinic successfully implemented same-day or next-day IV diuretic access in the Cardiology Clinic, resulting in reduced inpatient stays. Additionally, this created access for patients from the Pulmonary Clinic, which helped alleviate high volumes. Because of this success, there are plans to expand a similar IV diuretic model at other Froedtert & MCW cardiology clinics. This planned strategy will likely reduce admissions and readmissions.
