Multidisciplinary initiative to reduce 30-day readmissions in heart failure: a quality improvement perspective

Aim Hospitalisation for heart failure (HF) carries a high risk of readmission and adverse patient outcomes. We noticed a higher rate of readmissions for HF patients in a tertiary cardiac centre in Doha, Qatar. This study is focused on using a multidisciplinary and quality improvement approach to reduce the HF patients’ 30-day readmission rate to the high dependency unit C in Heart Hospital, Doha, Qatar, by 10% by December 2020 and 20% by December 2021. Methods In collaboration with the Institute for Healthcare Improvement, we worked on this initiative as a multidisciplinary team and tested several changes. A model for improvement framework was used and rapid, weekly, plan-do-study-act cycles were applied to test changes. Multiple measures were implemented serially, which included follow-up telephone consultations by a HF clinical nurse specialist 1 week after hospital discharge, early follow-up in a dedicated HF clinic (within 2 weeks of discharge), the availability of medical guidance over the telephone, comprehensive health coaching and education, patient functional activity engagement and cardiac depression screenings. Results The readmission rate reduced from 25.5% in 2019 to 5.6% in 2021 (p<0.001). The results achieved have been sustained over time, with readmission rates recorded at 7.87% to date. The study demonstrated a decrease in 30-day readmission rates for HF patients after implementing a multidisciplinary quality improvement initiative. Conclusions Reducing readmission rates underscores the importance of comprehensive patient education, tailored care plans, consistent follow-up and integrated team-based care in managing HF patients. The success of this initiative highlights the potential of multidisciplinary strategies in improving patient outcomes in chronic conditions like HF.