A HEART CARE NAVIGATION TEAM IMPROVES ACUTEMYOCARDIAL INFARCTION CARE AND OUTCOMES

BACKGROUND

William Downey, MD, FACC, FSCAI | Stephen Wright, MBA, RN | Ciearra Heidelberg, MPHShanie Ramirez, RN, MSN, CNML, CVRN-BC | Tom Draper, MBA | Amber Furr, BSN, RN, CPHQ

In 2017, a Heart Care Navigation Team was implemented to optimize acute myocardial infarction (AMI) care transitions in order to improve compliance with guideline-based care, reduce mortality and minimize avoidable readmissions.

One health advocate and two full-time AMI nurse navigators were hired in the summer of 2017. Using the Plan, Do, Study, Act methodology, the team’s work�ow evolved to

(1) enhance the discharging process with-out adding additional burden to the exist-ing clinical staff, and

(2) provide AMI patients with direct access to a clinical resource during and after the hospital stay.

During the inpatient encounter, the nurse navigator focuses on education, care co-ordination, and quality improvement. The team assists with timely access to follow-up care, promotes self-management, and addresses patients’ questions or concerns for a period of 90 days following hospital discharge. During this 90-day post dis-charge period the duration of care can reset if the patient has an additional inpa-tient encounter. This program is limited to weekdays during business hours.

METHODS

RESULTSPatients appropriate for heart care navigation were iden-ti�ed based on the criterion: principle diagnosis of AMI. During Aug17–July18 approximately 680 patients were found to be appropriate for navigation care. Comparing pre- to post- Heart Care Navigation Team implementa-tion (i.e., July16–June17 vs. Aug17–July18), our internal data showed a reduction in AMI 30-day same-facility re-admissions observed/expected ratios (0.58 vs 0.42) and well below the Premier Top Decile [0.69], a reduction in AMI 30-day observed mortality rate (5.75% vs. 4.57%), and an increase in AMI patients’ follow-up appointments made prior to hospital discharge (78% vs 96%). Data from the Chest Pain—MI Registry showed an increase in overall defect free care (83.3% vs 85.1%) and an increase in cardiac rehab referrals (85.7% vs 88.6%).

CONCLUSIONSResults indicate successful impact of the Heart Care Navigation Team at the System’s quaternary facility. There remains opportunity to improve defect free care, particularly referral to cardiac rehabilitation. Similar pro-grams were implemented at two additional tertiary care facilities within the System, both of which have yielded similarly positive results. Strengths of the program in-clude a one-on-one relationship between patient and Heart Care Navigator team through the care transitions and a strong collaborative relationship between the team and providers.

CLINICAL IMPLICATIONA well-designed Heart Care Navigation team appears to improve guideline-based care and patient outcomes.

BaselineSep-17

Oct-17Nov-17

Dec-17Jan-18

Feb-18Mar-18

Apr-18May-18

Jun-18Jul-18

Aug-18Sep-18

Oct-18

30-Day Observed Mortality Rate

30-Day AMI Observed Mortaltiy Rate (rolling year) Target (5.25)

All Hospitals 75th%All Hospitals 90th%% Overall Defect Free Care All Hospitals 50th%

Q2 2017Pre Nurse Navigator

Q2 2018Post Nurse Navigator

6.5

6.0

5.5

5.0

4.5

4.0

FAVORABLE

Sep-17Oct-17

Nov-17Dec-17

Jan-18Feb-18

Mar-18Apr-18

May-18Jun-18

Jul-18Aug-18

Sep-18Oct-18

Follow-up Appointments Made Prior to Discharge

AMI Patients’ Follow-up Appointments Made Prior to Discharge Target (80%)

Chest Pain-MI Registry Overall Defect Free Care

Lead Investigator: Dr. William Downey | No faculty disclosures

Chest Pain-MI Registry Inpatient Cardiac Rehab Referral

100%

90%

80%

70%

60%

50%

FAVORABLE

BaselineSep-17

Oct-17Nov-17

Dec-17Jan-18

Feb-18Mar-18

Apr-18May-18

Jun-18Jul-18

Aug-18Sep-18

Oct-18

AMI 30-Day Same-Facility Readmissions O/E Nurse Navigator Work�ow

Navigator Patient Coverage Timeline

AMI 30-Day Same-Facility Readmissions O/E (rolling year) Target (0.69 Premier Top Decile)

0.75

0.70

0.65

0.60

0.55

0.50

0.45

0.40

0.35

0.30

FAVORABLE

100

90

80

70

83.381.9

90.6

95.9

85.1

96.8

All Hospitals 75th%All Hospitals 90th%% Cardiac Rehab Referral All Hospitals 50th%

Q2 2017Pre Nurse Navigator

Q2 2018Post Nurse Navigator

100

90

80

70

85.788.6

IdentifyPatients

PatientRounding

AddressNeeds &Concerns

PostDischargeContact

CreateDaily

Worklist& Task

Poster design and printing by Blazon Productions, LLC

89.3

100.0

If Readmitted,ED Visit, Obs

90 Days AfterHospital Discharge

Hospital Admission(Day One)