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)