Heart Failure Transplant Program Staffing Survey
The purpose of this study is to understand the staffing requirements for a heart failure program, a transplant program, or a
heart failure/transplant program.
Your answers will be grouped together with all other centers. We plan to disseminate the information gathered from this
survey and be sure, if you complete the survey, that you will receive a copy of the report.
Thank you for the time to complete this important document.
To begin, does your practice have any or do any of the following?
1. Outpatient heart failure program
2. Inpatient heart failure service
3. Perform mechanical circulatory support devices (MCSDs)
4. Perform permanent MCSDs (i.e. destination VADs)
Yes
Yes
Yes
Yes
No
No
No
No
5.
Do you have a heart transplant program at your principle place of work? (Required)
Yes (skip to question #7) No (go to question #6)
6.
Do you closely relate to a heart transplant program AND follow patients who have undergone transplant at your
center? Yes No
Program Volume
Heart Failure patients:
7. Heart Failure patient office visits per year:__________
MCSDs:
8.
9.
10.
11.
Destination VADs implanted per year (average 2001-2006):__________
Heart transplants in 2007:__________
Heart transplants in 2006:__________
Heart transplants in 2005:__________
Staffing
For the following questions, please indicate your total staff including heart failure and transplant programs.
12. Heart Failure M.D./D.O. Full Time Equivalents (#FTEs): __________
13. N.P./P.A. FTEs (inpatient and outpatient):
__________
14. R.N. Coordinator FTEs (inpatient and outpatient):
__________
Please specify the individual staff for your heart failure program and transplant program both.
Heart Failure Program:
15. Heart Failure M.D./D.O. Full Time Equivalents (#FTEs): __________
16. N.P./P.A. FTEs (inpatient and outpatient):
__________
17. R.N. Coordinator FTEs (inpatient and outpatient):
__________
Transplant Program:
18. Heart Failure M.D./D.O. Full Time Equivalents (#FTEs): __________
19. N.P./P.A. FTEs (inpatient and outpatient) :
__________
20. R.N. Coordinator FTEs (inpatient and outpatient):
__________
21. Does your MCSD program involve additional personnel other than what you recorded?
Yes, how many?___________________
No
Other HF Program Health Care Providers (#FTEs):
22. Financial Consultant:
__________
23. Social Worker:
__________
24. Exercise Physiologist:
__________
25. Nutritionist:
__________
26. Psychologist:
__________
27. Pharm D:
__________
28. Is additional staffing (outside of what is recorded above) available for device monitoring? (Required)
Yes (skip to question #30)
No (go to question #29)
29. Is staff available for monitoring of routine laboratory (i.e. INR) and non-device data? (Required)
Yes
No
Please indicate which of the following ways monitoring is conducted at your site, as well as if it is routinely done (you have a
program devoted to monitoring) or sporadic (you monitor patients as the need arises (i.e., an insurance company requests you
use a device and monitor specific patients).
Monitoring Conducted?
30. Electronic Home Monitoring System – multiple components (telephonic)Yes
No
31. Electronic weight and/or BP scale (telephonic or via web)
Yes
No
32. Internal cardiac device (including impedance, HR variability, activity)
Yes
No
33. Internal right ventricular hemodynamic monitor
Yes
No
Yes
No
35. Internet/fax data downloading (from external or internal device/filing)
Yes
No
36. Internet-based, real-time assessment (with 2-way visual and audio)
No
34. Telephone monitoring (outgoing/incoming)



Yes
Routine/ Sporadic?
37. Electronic Home Monitoring System – multiple components (telephonic) Routine
 Sporadic
38. Electronic weight and/or BP scale (telephonic or via web)
 Routine
 Sporadic
39. Internal cardiac device (including impedance, HR variability, activity)
 Routine
 Sporadic
40. Internal right ventricular hemodynamic monitor
 Routine
 Sporadic
 Routine
 Sporadic
42. Internet/fax data downloading (from external or internal device/filing)
 Routine
 Sporadic
41. Telephone monitoring (outgoing/incoming)



43. Internet-based, real-time assessment (with 2-way visual and audio)  Routine
44. Is staff available for monitoring of routine laboratory (i.e. INR) and non-device data? (Required)
Yes. (if yes, go to question #45)No (if no, go to question #47)
 Sporadic
45. Are the staff who do this Advance Practice RNs (Nurse Practitioner or Clinical Nurse Specialist)? (Required)
Yes (if yes, go to question #46)
No (if no, go to question #47)
46. Do they follow written algorithms to make treatment decisions?
Yes
No
47. When Patients with heart failure are hospitalized for acute decompensation, who takes care of them at your primary
hospital? (choose the best response)
 Hospitalist
 Cardiologist
 Heart Failure Cardiologist
 Primary care or other physician type
 Varies by floor/unit patient admitted to
 Varies by admitting diagnosis
48. Which of the following best describes your professional role?
 MD
 Resident Nurse
 Nurse Practitioner
 Pharmacologist
 Clinical Nurse Specialist
 Physician’s Assistant
 Practice Administrator
 Other, please specify________________
49. Which of the following best describes your primary practice setting?
 Cardiovascular Group
 Government Hospital
 Non-Government Hospital
 HMO Group/Staff Model
 Medical School
 Solo Practice
 Other, please specify________________
50. Would you like to receive a copy of the research results (if yes, please indicate your email address)
 Yes, Email:_________
 No
Please provide your practice/program information: (Required)
Practice/Program Name:_______________________________________________
Practice/Program State:________________________________________________
Practice/Program Zip:__________________________________________________
And lastly, please provide any other thoughts you may have regarding staffing a heart failure program:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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