Background: Heart failure (HF) is a serious condition and a major health problem in the United States with significant associated costs. Despite major advances in treatment, standardized performance measures, and evidence-based national guidelines, heart failure continues to be a substantial cause of mortality and morbidity. Since the early 1990s, improving patient safety and chronic disease outcomes has become a national priority. In an effort to improve the healthcare delivery process, a healthcare accreditation organization, The Joint Commission (TJC) developed evidence-based performance measures for HF and three other chronic diseases. Other organizations, such as the Institute of Medicine (IOM) and the Institute for Healthcare Improvement (IHI), have started campaigns with targeted interventions for improving the care of patients with HF. Foreground: Healthcare organization compliance with performance measures is one of the requirements for obtaining and maintaining accreditation and certification status from TJC. While a group of hospitalist providers at local facility, accredited by TJC, recognized the effects of HF, they were not consistently complying with the HF performance measures. Additionally the group did not have a standardized protocol in place for the performance measures or for the discharge process for patients with HF. Objectives: The capstone project was an evidence-based outcomes management plan directed at improving the care of patients with HF by changing clinical practices. The short term objectives of the project were to: (a) create a standardized HF discharge protocol based on the four HF performance measures (b) implement the protocol at the facility for patients with HF admitted to the hospitalist provider’s service and (c) evaluate the hosptialist provider’s compliance with the four HF performance measures both before and after implementation of the protocol. Long-term project objectives included laying a foundation for future development and use of standardlized discharge protocols for all patients admitted to the facility. Evidence-Based Practice/Theoretical Framework: The evidence-based framework used for the project was A Model for Change to Evidence-Based Practice. The six steps of the model provided the structure and guided the project. The findings in the literature reviewed for the project provided the theoretical framework; the use of a standardized protocol based on performance measures has the potential for significant improvement in the care and outcomes of patients with HF. Results: The use of a standardized HFdischarge protocol did increase the facility hospitalist provider’s compliance with the four HF performance measures. After protocol implementation, statistical analysis continually improved, with 100% compliance in all four measures in four of the five months evaluated by the facility. Two out of the four months evaluated by the hosptialist management company, after initiation of the protocol, had 100% compliance in all four measures. Conclusion: Prior to implementation of the standardized HF discharge protocol, the hospitalist group provders in the facility were not consistent with meeting the four HF performance measures of TJC. Statistical data revealed the group’s compliance to be as low as 80% at times and only occassionallyat 100% but never in all four HF measures. After implementation of the protocol, compliance of the hospitalist provders consistently improved. The facility’s data showed 100% compliance in all of the HF performance measures in four of the five months after implementation. While only four months post implementation data from the hospitalist management company was available for review, those statistics also showed improved compliace with 100% in all four measures in two of the four months. Evidence-based interventions provide the road map for optimal treatment of HF and have the potential to facilitate improved outcomes in patients with HF. This is even truer if the interventions are in a standardized format and executed by a team approach. To date, there have been few studies to evaluate the process for successful implementation for these interventions into clinical practice. More emphasis needs to be placed on incorportating best evidence into everyday medical care.
