Summary

A Clinical Practice Improvement study was conducted at a mid-Atlantic hospital to determine areas of significant improvement in the management of congestive heart failure (CHF) patients. Data were collected on 116 patients (with 384 admissions over 24 months); extensive multivariate analyses were performed. Results show that longer length of stay was associated with drug underdosing and that more admissions were associated with not giving education, as well as noncompliance with diet by patients. The study team is using the study results to develop research-based dynamic protocols to improve management of CHF patients.

Primary Objectives

Examine areas of inconsistent practice and therefore likelihood for errors in management of CHF patients.

1. Patients with CHF and coexistent hypertension diagnosis.
   

2. Patient education process, including documentation and gender differences.
   

3. Patient noncompliance with diet and medications.
   

4. Use of ACE inhibitors relative to severity of illness (creatine, low systolic blood pressure), target dose, and education.
   

5. Timing of diuretics.

Methods

Data were collected on 116 patients (age 41-81+ years; 74 female, 42 male; 384 admissions). Multivariate analyses were performed on all data.

Results

1. Greater number of days before administering diuretics was associated with longer length of stay and higher total charges.
   

2. Underdosing Enalopril in patients with low ejection fraction and underdosing Lisinopril were associated with longer length of stay.
   

3. Patients with documented education had fewer subsequent admissions.
   

4. Patients with psychiatric comorbidities or who were noncompliant with diet had more subsequent admissions.

Impact

More appropriate and timely drug therapy with ACE inhibitors and diuretics, consistent patient educational interventions, and greater attention to comorbid psychiatric conditions can improve the management of CHF patients and reduce the $8,500 average cost per CHF patient admission.