Nurse-led Advocacy in Reducing 30-Day Readmission Rates for Heart Failure Patients with Reduced Ejection Fraction

Background: Heart failure with reduced ejection fraction (HFrEF) is associated with increased mortality, morbidity, and readmission rates. Evidence-based practice outlines that HFrEF patients should be on guideline-directed medical therapy (GDMT), including medication from four categories: renin-angiotensin system inhibitors, β-blockers approved for the treatment of heart failure, aldosterone antagonists, and sodium-glucose cotransporter 2 inhibitors. Nurse-led patient advocacy for patients to be discharged on GDMT can help reduce 30-day readmission rates in patients with HFrEF in an inpatient heart failure unit. The purpose of this project was to implement a new practice involving the utilization of a discharge form and empowering nurses to advocate for patients through education. Methods: A collaborative team initiated this quality improvement project utilizing Lewin’s Change Management Model of Unfreeze, Change, and Refreeze to reduce 30-day readmission rates for HFrEF patients. The project included nursing education, creating and using a discharge form as a tool for nurse-led advocacy, and creating a Heart Failure Committee. Patients with heart failure on an inpatient telemetry unit who had a reduced ejection fraction of 40% or less were included in this project. Patients were excluded if they had a preserved ejection fraction greater than 40%, were transferred or discharged from another level of care, transitioned to hospice, or expired. Results: A total of 205 patients met the inclusion criteria and were included in this quality improvement project. Of these 205 patients, 11 were readmitted within 30 days, a readmission rate of 5.4% for HFrEF patients. Conclusion: Nurse-led advocacy demonstrated positive outcomes with a 30-day readmission rate of 5.4% (n = 11 for all-cause readmissions and 2.9% (n = 6) for heart failure readmissions. The implementation of an HFrEF discharge form facilitated and streamlined nurse-led advocacy. The discharge form and nurse-led advocacy positively impacted the unit’s overall 30-day readmission rate for all heart failure patients (both preserved ejection fraction and reduced ejection fraction), reducing it from 17.96% in fiscal year 2023 to 16.0% in fiscal year 2024 so far. This reduced rate is 4.1% below the Center for Medicare and Medicaid Services (CMS) hospital comparison benchmark of 20.1%.