Key success criteria for the creation of an outpatient heart failure clinic
July 23, 2019
By Deb Thompson
Heart failure patients can be a challenging population to manage in the cardiovascular arena. As the prevalence of heart failure continues to be significant, the American Heart Association 2019 Statistics Data update reports 6.2 million adults had heart failure between the years of 2013-2016, and close to 4,000 were on a heart transplant list. What opportunities do we have to improve the care of the heart failure patient and maximize the caregiver and patient experience?
As healthcare professionals, we have a responsibility to focus on improving the health of our consumers. Certainly, prevention remains at the center when we spotlight cardiovascular disease. The AHA refers to them as “Life’s Simple 7”. This refers to those key behaviors in which we can monitor to decrease our risk for development of heart disease. Eliminating smoking and increasing physical exercise to 60 minutes per day go a long way in prevention. Focusing on a well-balanced nutritional diet to curb obesity, which is currently reported at 37.7 percent of all adults, and close monitoring cholesterol targets is critical. It is documented that 46 percent of all adults have some degree of hypertension, and along with the management of diabetes, it can be challenging but necessary for long-term management of the cardiovascular patient.
The focus on prevention is important as the projected increase in U.S. heart failure population from 2014-2030 is expected to increase by 46 percent. However, once a patient has had heart failure diagnosed, the financial burden of care will be important to us, as healthcare providers, not only in the inpatient setting but also in the continued shift to the outpatient setting.
Managing patients in an outpatient heart failure clinic can provide patient education and access to resources to enable patients to optimize their condition and remain out of the acute care setting. Hallmarks of an efficient heart failure clinic include a multidisciplinary care team, management of co-morbidities, measurements of key performance indicators and efficient, coordinated care.
Heart failure patients are living longer and their co-morbidities are not just limited to the cardiovascular system; diabetes, COPD, and renal insufficiency can complicate the care of these patients. Development of a multidisciplinary team will allow for timely care as well as decrease silos as the demand for care increases. As the symptoms of heart failure advance, the availability of electrophysiologists and structural heart practitioners in the clinic is vital to enhance the delivery of highly coordinated care.
Effective leadership is critical for the heart failure clinic. Health Care Advisory Board reports greater than 50 percent of clinics are managed by an Advanced Nurse Practitioner (ANP). This allows the physician to focus their time on high intensity care issues. It is important for the care team to understand their roles to work together for the patient. All team members working at top of license will maximize capacity within the clinic.
Is there opportunity to define the workload based on patient and family needs? The physician has an opportunity to see new patients in hospital consults to support the sickest of patients. The ANP may see post discharge visits, and less complex consults resulting in all patients seeing a practitioner who has advanced knowledge in the care of the heart failure patient. Non-clinical staff can manage the administrative tasks, resulting in efficient throughput to support additional capacity in the heart failure clinic.
A well-coordinated and engaged team is the foundation of a successful heart failure clinic. An understanding and development of dashboards to monitor such key performance indicators as readmission rate, wait times for access to the clinic, use of ACE inhibitors, and monitoring of “Life’s Simple 7” in follow up visits post discharge, to name a few), will support the goals of the heart failure clinic. Finally, an engaged team with the passion to care for patients with heart failure will improve the care long term and optimize the patient and family experience across the care continuum.
About the author: Deb Thompson, MBA, BSN, RN is the senior consulting manager for Cardiology at Philips. Deb brings over 25 years of cardiology nursing and leadership experience. She provides performance improvement strategies with hands-on process change support for interventional as well as noninvasive cardiology in the acute care and outpatient settings.