Implementation of a self-care intervention for patients with heart failure discharged from the emergency department: implementation findings from a multicenter hybrid type 2 implementation study

Patients with acute heart failure (AHF) discharged directly from emergency departments (EDs) are at high risk for 30-day revisits, readmissions, and mortality. Most transitional care interventions have focused on inpatient settings, thereby excluding this vulnerable population. Our team developed a self-care coaching intervention called Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) to address care transitions for patients with AHF discharged from EDs, aiming to improve patient self-management and clinical outcomes. We describe the implementation outcomes of a large hybrid type 2 study conducted across six EDs in two geographically diverse healthcare systems, guided by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Care Transitions Intervention frameworks. We employed a multifaceted implementation strategy that included a best practice alert in the electronic health record, identification of local champions, educational meetings, and implementation of audit and feedback mechanisms. Data was collected through ED staff surveys, electronic health records, and monthly tracking sheets to assess implementation outcomes of reach, adoption, implementation, and maintenance. Clinical effectiveness is reported elsewhere. The study reached 37% of eligible patients (67% in one healthcare system, 14% in the other), with 47.5% of ED encounters resulting in adoption of GUIDED-HF. Reported median scores for implementation climate and staff involvement were higher at 24 months when compared with baseline scores. Feasibility, acceptability, and appropriateness ratings were consistently high over the 24-month study period. Lessons learned include matching implementation strategies to specific contextual factors; we found this critical for overcoming barriers and enhancing implementation success. Variability in implementation outcomes across the examined healthcare systems underscores the importance of tailoring implementation approaches to local contexts and involving stakeholders in strategy development to maximize intervention adoption and effectiveness. Our hybrid design implementation study demonstrated an evidence-based approach to implementing a self-care intervention for patients with AHF in ED settings, contributing to the limited knowledge base in this area. Future research should focus on scaling GUIDED-HF across diverse healthcare settings, addressing specific implementation barriers, and refining implementation strategies. n/a.