Best Practices - HF

The Centers for Medicare & Medicaid Service (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) together developed core measures to be used to increase quality of care for heart failure patients. The measures related to treatment for heart failure are:

• Perform a left ventricular function (LVF) assessment
• Giving an ACE inhibitor for left ventricular systolic dysfunction
• Giving full instructions at discharge
• Providing advice/counseling on how to stop smoking

Care delivered in a hospital is the result of a number of practitioners interacting within a complex system. Staff working to deliver high quality care can examine the evidence-based guidelines for heart failure and create a standard pathway or guideline for promulgating care at their hospital that conforms to the performance measures. Guideline development and implementation requires coordination among the medical and nursing staffs and a commitment of resources. Many examples of guidelines and care paths have been developed by providers and others to use as references when developing the institutional guideline or care pathway. Some of these examples are detailed in the following paragraphs.

The Maryland Health Care Commission in coordination with CMS and JCAHO recommend Hospital Leaders employ the following best practices:

• Develop a heart failure admission order set that details appropriate care of heart failure patients
  
  The Admission process can be the source of planning errors for patients with heart failure. Using an accepted preprinted order set or checklist can significantly reduce errors and stimulate all practitioners and the staff responsible for admitting patients to approach care with the same plan for desired care at the hospital.
• Develop standing orders for heart failure care to ensure guideline compliance.
  
  A standing order relieves the practitioner of the responsibility to remember all elements of the desired care, freeing them to concentrate on acute issues necessitating the admission at the hospital.
• Participate in a heart care collaborative with other hospitals.
  
  A heart failure collaborative allows hospitals to spread and adapt knowledge about what already works rather than trying out new ideas through research or pilot studies. It uses a change management method that is designed to identify where a change actually leads to an improvement, where changes are tested in small cycles so that they are manageable, and where changes are measured so that the improvement can be demonstrated. Several organizations offer facilitation of collaboratives, particularly the Quality Improvement Organization in Maryland, the Delmarva Foundation, Inc.

In addition, the Medicare Quality Improvement Community recommends the following hospital quality improvements for heart failure. Follow the “Quality Improvement” link for administrators on the Medicare Quality Improvement Community website: www.medqic.com.

• Develop standing or preprinted orders consistent with guidelines for heart failure care (see below)
• Condense current science into quick reference tools for heart failure
• Create a quality improvement community with other area hospitals to improve care in your area
• Post data on performance measures in a common area of the hospital where staff can see them
• Develop performance measures for Board of Directors’ quality improvement activities
• Begin a program for senior leaders to learn care delivery by working closely with a unit at the hospital
• Make physician performance measures a criterion for admitting privileges
• Develop tools to track quality improvement activities or outcomes
• Develop a guideline tailored for a microsystem within the hospital
• Develop recognition programs to reward quality improvement activities and achievements

To help hospital administrators improve their care for patients with heart failure, many on-line tools are available including these:

• ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. This full text report of the American College of Cardiology/American Heart Associate Task Force on Practice Guidelines (2001) was developed in collaboration with the International Society for Heart and Lung Transplantation. Endorsed by the Heart Failure Society of America. Visit the American Heart Associates' Heart Faiure pages.
• “Heart Failure Practice Guidelines.” Originally published in The Journal of Cardiac Failure, 1999;5:357-382. Reprinted in Congestive Heart Failure, 2000;6:11-39. See it at: www.hfsa.org/hf_guidelines.asp.
• “Get With the Guidelines-Heart Failure” sponsored by the American Heart Association. Find out more by clicking on “Getting Started Online Course” at: www.americanheart.org/presenter.jhtml?identifier=3029030.
• Health Care Excel offers a template of stickers to attach to patient charts that outlines the national guidelines for Heart Failure care. Find it at: www.hce.org/Medicare/PDF_Documents/HF_stickers.pdf.
• Health Care Excel offers a wall poster that outlines the national guidelines for Heart Failure care. Find it at: www.hce.org/Medicare/PDF_Documents/small_HF_poster.pdf.

Through this website, Maryland patients, providers, and other hospital executives can research the quality of patient care at all Maryland hospitals, choosing the one that fits their needs best.

You should become familiar with the performance measurements and outcomes shown on this site to answer questions from your Board, staff, physicians and patients regarding your hospital’s record on the core measures for heart failure.