Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility

Michelle S Rockwell; Emily Cox; Tonja Locklear; Brandy Hodges; Stacey Mulkey; Brandon Evans; John W Epling; Anthony R Stavola

doi:10.1177/23337214221149274

Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility

Gerontol Geriatr Med. 2023 Feb 3:9:23337214221149274. doi: 10.1177/23337214221149274. eCollection 2023 Jan-Dec.

Authors

Michelle S Rockwell^{1

2}, Emily Cox¹, Tonja Locklear¹, Brandy Hodges³, Stacey Mulkey³, Brandon Evans³, John W Epling^{1

2}, Anthony R Stavola^{1

3}

Affiliations

¹ Carilion Clinic, Roanoke, VA, USA.
² Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
³ Friendship Health and Rehabilitation Center-South, Roanoke, VA, USA.

Abstract

Hospitals and skilled nursing facilities (SNFs) are incentivized to reduce hospital readmissions among patients with heart failure (HF). We used the RE-AIM framework and mixed quantitative and qualitative data to evaluate the implementation of a multimodal HF management protocol (HFMP) administered in a SNF in 2021. Over 90% of eligible patients were enrolled in the HFMP (REACH). Of the 42 enrolled patients (61.9% female, aged 81.9 ± 8.9 years, 9.5% Medicaid), 2 (4.8%) were readmitted within 30 days of hospital discharge and 4 (9.5%) were readmitted within 30 days of SNF discharge compared with historical (2020) rates of 16.7% and 22.2%, respectively (a potential savings of $132,418-$176,573 in hospital costs) (EFFECTIVENESS). Although stakeholder feedback about ADOPTION and IMPLEMENTATION was largely positive, challenges associated with clinical data collection, documentation, and staff turnover were described. Findings will inform refinement of the HFMP to facilitate further testing and sustainability (MAINTENANCE).

Keywords: 30-day readmission; hospital; quality improvement; remote dielectric sensing.