When HF patients are admitted, they often face inconsistent care among the three to eight different hospitalists and cardiologists that care for them. UPMC’s CHF Hospitalist program sought to create consistency by developing a standard order set and having one provider care for patients across hospital visits.
CHF hospitalists work together to establish protocol
Currently, the CHF hospitalist team consists of four physicians and three Advanced Practice Providers (APPs) who are passionate about improving outcomes through frequent patient rounding and communication. At every visit, the team checks and tracks key information through a standard template. All care team members can start a patient on HF medications, unlike many health systems that rely on cardiologists to do so. The CHF hospitalist team currently abides by HF guidelines, including the “four pharmacological pillars” of HF care: diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and Lanoxin. CHF hospitalists only contact other specialists when intervention is necessary to ensure that added expertise will positively impact the patient.
Current team members became comfortable with protocol by six to twelve months. To make changes to the protocol, team members conduct literature reviews and discuss the protocol alterations. For instance, when a new medication comes out (e.g., SGLT2 inhibitors), the team discusses how to use those with new patients. The frequent cadence of communication and dialogue helps the team find what is best for patients. Further, by collaborating, the staff have natural buy-in for agreed upon protocols as well as a regular opportunity to advocate for worthwhile changes.
Patient information from multiple visits is tracked through a standardized template
UPMC’s CHF hospitalist program aims to pair any returning patients with the same CHF hospitalist from their previous admission, to keep care consistent. CHF hospitalists track important information about the patient through a specialized template unique to the program. The template includes:
- Clinical records (e.g., current heart failure medications, HF order set, most current echocardiogram, number of admissions in the last year)
- Cause of case exacerbation (e.g., diet choices, non-compliance with medication, poor family support)
- Co-morbidities (e.g., baseline renal function, CKD stage)
- Social support (e.g., financial restraints, home status)
The information is manually inputted into patient charts so that if a patient is readmitted to UPMC Harrisburg, their previous inpatient visit information will be readily available to any admitting provider and their designated member of the CHF hospitalist team. This ensures patients receive care that is in line with previous clinical recommendations so they can recover as smoothly as possible.