Optimizing CHF Management in the Post-Acute and Long Term Care Setting via Flexible Diuretic Dosing  

Michelle Johnson and Jennifer Thiesen

Congestive Heart Failure (CHF) is one of the primary causes of hospitalization at Cambridge Health Alliance. In addition to being costly, the care of these patients is complex as these patients often have multiple comorbidities that can mimic and exacerbate a CHF exacerbation. There is a high risk for readmissions for patients with CHF from the post acute care setting. Evidence is lacking for if protocol-driven titration of diuretic therapy in the post acute setting could be effective in preventing rehospitalization. The aim of this project is to reduce unnecessary readmissions by optimizing the management of CHF in the post-acute and long term care setting via protocol-driven titration of diuretic therapy. We plan to do this by creating standardized order sets for all CHF patients at the collaborating SNFs. Additionally, we will provide training and educational material to SNF staff, patients and patient families on detecting early symptoms of CHF exacerbations. Finally, we will establish a protocol to initiate flexible diuretic dosing if the patient meets criteria for a CHF exacerbation. Our primary outcome is 30 day readmission rate for any cause. Secondary outcomes include reducing LOS from hospital to home and improving SNF staff confidence in detecting CHF exacerbations and patient satisfaction with their CHF care at the SNF.