2013 CNL® Summit
January 17-19, 2013
Abstract Submission Form
Abstract title: Project Red: Reducing CHF Readmissions
Authors & credentials: Claire Gangware, MSN, RN, CNL
Institution: Jesse Brown VA Medical Center
City/State: Chicago, Il
Primary Contact Email: claire.gangware2@va.gov
Instructions: Please complete each of the following sections, when applicable. Each section
should contain between 50 and 250 words, using Times New Roman, 12 point font.
Background Information:
Jesse Brown VA Medical Center formed an interdisciplinary team in October, 2011 to
implement AHRQ's Project Red. Project Red (Re-Engineered Discharge) is a patient centered
approach designed to standardize discharge planning and discharge education. Leadership
identified CHF readmission rates as an area for improvement.Our initial team consisted of the
Chief of Medicine, Chief of Hospitalists, Director of Performance Improvement, Performance
Indicator Measures Reviewer, Discharge Pharmacist, Medicin/Oncology unit Nurse Manager,
CNL, Clerk, Dietician, Heart Failure Clinic Nurse Practitioner, and Social Worker.
Aim:
Project Red (Re-Engineered Discharge) improves the patient's preparedness for self care after
discharge, thus decreasing hospital readmission. It was initially developed through research
funded by AHRQ. AHRQ has funded Joint Commission Resources to assist hospitals with the
implementation. JBVAMC implemented Project Red with a goal of reducing readmissions for
heart failure patients.
Methods/Programs/Practices:
The first meetings included viewing the Project Red training modules which were developed by
Joint Commission Resources, Inc. Current practice was developed into a process map which
identified barriers and issues. Next we developed an "Ideal State" flow map which deliniated
team member responsibilities.The major areas of the project included:
*patient education of self management of heart failure using a "teach-back" methodology,
*patient education of medication changes upon discharge,
*printed discharge instructions,
*timeliness of discharge appointments in the Heart Failure Clinic and/or primary care provider,
*follow-up discharge telephone call
ADVANCING HIGHER EDUCATION IN NURSING
One Dupont Circle NW, Suite 530 ∙ Washington, DC 20036 ∙ 202-463-6930 tel ∙ 202-785-8320 fax ∙
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*enrollment in Care Coordination Home Telehealth (CCHT).
Physicians improved discharge instructions and solved the problem of patients often receiving
incongruent medication lists. Nursing developed the Heart Failure Management Guide to teach
patients and established a consistent process for documentation. The clerk addressed a workable
process for scheduling rapid-return clinic appointments at discharge. Dietary provided
supporting materials and teaching about fluid restriction and low sodium diet. CCHT evaluated
Project Red patients prior to discharge for possible enrollment in the telehealth program. Our PI
Measures Reviewer documented metrics for each patient in the program. The measurable metrics
include: documentation of patient education, discharge teaching of medications, follow up
appointment within 7 days, discharge follow-up phone call, enrollment in CCHT.
The CNL was primarily responsible for identifying patients for the program, patient education
using "teach back", and documentation of the above. The CNL also made the discharge followup phone call within 48 hours to identify current or potential problems for the patients at home.
During the pilot on 5West of 12 patients, it was identified that patients receive several different
phone calls after discharge. To streamline that issue, Patient Aligned Care Team (PACT) agreed
to include questions specific to heart failure in their existing discharge phone call. The Project
Red Team designed a new electronic format for the phone call.
We proceeded to full scale deployment on 5West, loosening our criteria to patients with primary
or secondary diagnosis of Heart Failure. Once the program was functioning smoothly it was
expanded to include 4E, Telemetry/Stepdown which has the majority of heart failure patients.
Additional staff from 4E were added to the team; the CNL, Clerk and Dietician. Eventually
Project Red will be operational in all acute care units
Outcome Data
Proclarity data for JBVA :
Readmission for CHF
2012 Q1 35.2%
2012 Q2 26.4%
2012 Q3 13.5%
In the four months after the implementation of Project Red, the number of HF readmissions
dropped to18 compared to 28 readmissions in the prior four months of FY 2012. This resulted in
an approximate cost savings of $136,500.00 for our facility.
Conclusion:
Although the project has not yet been implemented house-wide, we are already realizing
improvement in HF readmissions, a 21.7% reduction from Q1 2012 to Q3 2012. Equally
important is that by implementing Project Red, our patients are receiving a consistently higher
level of education and support to assist them in self management. Patients receive education
prior to their HF clinic appt which allows the NP to practice in a more efficient, supportive role.
An unintended benefit of Project Red is higher numbers of patient enrollment into CCHT which
supports the patient at home as well as helping CCHT to meet their enrollment goals.
AACN Call for Abstracts, 2013 CNL Summit
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