New Ways of Treating Congestive Heart Failure at Bon Secours Baltimore Health System

For patients admitted to Bon Secours Hospital and diagnosed with congestive heart failure, the outcome is bright. The new Bedside Patient Education program is changing patient behavior and having a major impact on the number of returning cardiac patients.

“We had to rethink our strategies around patient care,“ says Dr. Athol Morgan, Chief of Cardiology at Bon Secours Baltimore Health System. “Too many of our congestive heart failure patients were returning to our Emergency Department for care of emergent health problems.”

In 2009, the Cardiology Department of Bon Secours Hospital launched their new patient education program. The program begins while patients are still in the hospital. “The most common reasons for repeat Emergency Department visits are failure to comply with education, diet instructions, and lack of follow-up with a physician,” comments Dr. Morgan. “We’ve established this program using existing resources. It contains both an in-patient and out-patient component.”

The in-patient portion of the new program includes a visit by TeleHeart nurse Joe Ann Murphy. “Once a patient has been in the hospital for two or three days, they are able to focus on the education materials that I provide,” says Joe Ann Murphy, RN. The tools Joe Ann gives each patient are easy to understand and remember, and they put some control back into the patients’ hands. “One of the reminders is a picture of a scale and a reminder to weigh themselves every day. If they gain three to five pounds from one day to the next, then they need to call their primary care physician, their cardiologist or me. We’ll get them in for a visit either that day or the next to adjust their medicine or determine what needs to be done,” says Joe Ann. The weight gain is an indication of fluid retention and, if left untreated, would result in a return visit to the Emergency Department within just a few days. “This is something they can do and see,” Joe Ann continues, “This everyone can understand!”

After discharge, follow-up with patients includes assistance and support with their adherence to diet and medication plans, exercise and self-monitoring of their heart condition. The TeleHeart nurse provides phone consultations and in-home visits to patients, as well as classes at the hospital three times each month. “We’re helping make patients more responsible for their health and showing them better health choices,” says Joe Ann.

For many patients, each day means making the choice of how to spend their limited resources, literally it’s a choice between food and rent or prescription drugs to treat their congestive heart failure. Every dollar is a choice and the prescription can be overlooked until there’s a need for critical care resulting in another trip to the Emergency Department. The readmission rate of congestive heart failure patients since the inception of the program is just over 10%, down from more than 13% a year ago.

“Meeting with the patients while they are here, onsite, has made a difference.” says Dr. Morgan. “The results have been very positive.” The success of the program lies not only in the decline of the readmission rate, but the increased use of prescription medication and increases in physician consultations after discharge, both indicators of the patients’ increased knowledge and commitment to working with staff to handle the disease. By utilizing hospital staff, volunteers and TeleHeart program personnel, the Cardiology Team is making a difference in CHF patients and their improved quality of life.