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HAP Achievement Awards Spotlight: Washington Health System

December 31, 2018

HAP Achievement AwardWashington Health System was awarded HAP’s “Excellence in Care” 2018 Achievement Award for its Ambulatory Heart Failure: Pathway to a Better Life initiative. By focusing on congestive heart failure care and developing a structured approach—or pathway—and incorporating best practices into the program, the team at Washington Health System improved the quality of life for heart failure patients, and reduced emergency room utilization and time spent in the hospital, allowing patients more time at home.

Americans with congestive heart failure experience high rates of frequent hospital utilization, poor quality of life, and high mortality compared to other chronic conditions. Often, these patients have multiple comorbidities with the most common being a later stage of renal failure. By using a collaborative care approach and a patient-centered strategy, Washington Health System implemented an Ambulatory Heart Failure Pathway to guide patients from inpatient to outpatient, self-managed care.

The program features a Heart Failure Navigator who:

  • Provides patient and family support
  • Assists with care management
  • Provides education as well as stressing to the patient and family the importance of adherence to diet, medications, and follow-up appointments

The availability of a navigator provides patients with prompt answers to their questions or concerns, allows for prescription changes if needed, and alleviates the anxiety patients and their families often feel when waiting for a call back from a physician’s office.

Patient enrollment in the ambulatory pathway includes:

  • Daily review of inpatient lists to identify patients meeting the criteria to be enrolled in the program
  • A meeting of the patient and family with a Heart Failure Navigator about the transition to the outpatient self-management program, during which the navigator provides education about the condition, stressing the importance of medication compliance, a structured low-sodium diet, contact information, and a weight log
  • Providing appropriate medical equipment (digital scales, blood pressure cuffs, pill boxes) to the patient, funded by grant money
  • Setting up an alert in the patient medical record noting that the patient has a Heart Failure Navigator
  • Follow-up phone calls by the Heart Failure Navigator following discharge, and scheduling follow-up appointments
  • Discussions initiative by the Heart Failure Navigator with the patient and family about hospice care if applicable

A Congestive Heart Failure Urgent Care Clinic is an integral part of the success of the program. Being able to utilize the clinic saves patients and families trips to the emergency room—and a possible observation/inpatient admission—for patients requiring unscheduled services, like IV diuretics. Patients gained the convenience of spending more time at home and less of their time in the hospital.

Due to the success of the pilot, a second Heart Failure Navigator was added, allowing for the program’s expansion to private practices in the service area. This expansion allows Washington Health System to engage and improve the quality of care for even more patients in its community.

HAP congratulates Washington Health System for its receipt of the HAP “Excellence in Care” 2018 Achievement Award.

Each year HAP recognizes hospitals from around the state that develop innovative programs to improve the quality of care, patient experience, and technology to meet the needs of the communities that they serve.

Questions about the HAP Achievement Awards may be directed to HAP Member Services at (717) 561-5359.

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