What is the clinical evidence from this study?

Study design: Cohort. Population: Congestive heart failure (n=332). Intervention: Multidisciplinary rounds (MDR) vs. Usual care (before implementation of MDR). Primary outcome: 30-day all cause readmission rate (RR 0.62, p=0.026).

July 1, 2019Open Access

Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients

RCRaghuram ChavaDartmouth–Hitchcock Medical Center NKNabin Raj KarkiUSA Mitchell Cancer Institute KKKerunne S. KetlogetsweMedStar Harbor Hospital

Key Result

Multidisciplinary rounds significantly reduced 30-day all-cause readmissions from 27.56% to 17.22% (RR 0.62) in patients hospitalized with congestive heart failure.

Study Design

Type

Cohort (n=332)

Multicenter

Structured PICO

Do multidisciplinary rounds reduce 30-day readmissions and length of stay in hospitalized patients with congestive heart failure?

Population

332 hospitalized patients with a primary admission diagnosis of congestive heart failure (CHF) in a community teaching hospital (181 in the before period, 151 in the after period).

Intervention

Multidisciplinary rounds (MDR) team consisting of a staff cardiologist, case manager, pharmacist, social worker, and a nutritionist.

Comparator

Standard care prior to the implementation of multidisciplinary rounds (retrospective 1-year before period).

Outcome

30-day readmissions and length of stayhard clinical

Implementation of a multidisciplinary rounding program significantly reduces 30-day readmissions and length of stay in patients hospitalized for heart failure.

Main Result

Effect estimate: RR 0.62

Absolute Event Rate: 17.22% vs 27.56%

p-value: p=0.026

Limitations

Retrospective nature
Small sample size
Single-center study
Lacked data to assess 30-day readmissions to other hospitals in the geographic area
Unable to segregate patients hospitalized with a new diagnosis of heart failure from those with an established diagnosis
Socioeconomic status of the population and its impact was not evaluated

Abstract

To assess the impact of multidisciplinary rounds (MDR) on 30-day readmissions and length of stay in hospitalized patients with a diagnosis of congestive heart failure in a community teaching hospital.Patients with primary admission diagnosis of congestive heart failure (CHF) were included. A before and after retrospective study was conducted once the intervention was implemented in 2014. The before and after study periods were each of 1-year duration and included 181 and 151 patients, respectively. Our multidisciplinary heart failure rounding team consisted of a staff cardiologist, case manager, pharmacist, social worker, and a nutritionist.The mean length of stay decreased from 5.7 days to 5 days, and 30-day readmissions decreased from 27.6% to 17.22% (P-value .026) after implementation of the multidisciplinary rounding. We observed a significant decrease of readmissions in ischemic cardiomyopathy (ICM) (from 33.61% to 14.01%; P-value .007) and heart failure with reduced ejection fraction (HFrEF) (from 31.34% to 16.05%; P-value .028) patients. There was an increase in the percentage of patients hospitalized with non-ischemic cardiomyopathy (NICM) and heart failure with preserved ejection fraction (HFpEF) and, in particular, women patients with heart failure.Implementation of MDR program on CHF patients resulted in significant decrease in both readmission rate and length of stay in our hospital.

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