New research conducted at St. Joseph Mercy Oakland Hospital, presented at the American College of Cardiology’s 61st Annual Scientific Session, reveals that a heart failure discharge checklist significantly reduces heart failure readmissions. The study shows that using a 27-question checklist can cut the 30-day readmission rate from 20% to just 2%.
The checklist is structured into three main sections: medications and appropriate dose adjustments, counseling and monitoring, and follow-up instructions. Each item focuses on proven management practices for heart failure patients. Dr. Abhijeet Basoor, MD, the lead investigator and developer of the checklist, explained that the average heart failure patient requires 12 to 15 interventions from the list to effectively reduce the risk of a subsequent cardiac event. To see how these steps can be applied at your facility, download our heart failure checklist for practical guidance.
“The checklist provides simple reminders to instruct patients about things like diet, weight, blood pressure monitoring and appropriate drug dose up titration. […] The physician or nurse practitioner working with the patient uses the checklist, so hospitals don’t have to pay for additional nursing staff or home care follow-up.”
Dr. Abhijeet Basoor, MD
Heart failure treatment is not only prevalent but costly. In the United States, it incurs an annual expense of $29 billion, with readmissions alone costing hospitals an average of $2,084 per patient per day. According to the Kaiser Family Foundation, heart failure readmissions account for $12 billion in Medicare spending each year. Approximately 25% of Medicare patients with heart failure are readmitted within 30 days of a cardiac event.
Given that prior studies indicate that 50% of these readmissions are preventable, Medicare plans to penalize hospitals with high readmission rates by withholding reimbursements under the Affordable Care Act.
Dr. Basoor emphasized that the checklist not only reduces 30-day and six-month readmissions but also improves patient adherence to correct medications and doses.
“In addition to lowering 30-day and 6-month readmissions and the associated costs, we also showed that more patients in the checklist group were likely to be on correct medications and had appropriate drug doses than patients in the control group.”
Dr. Abhijeet Basoor, MD
Access our comprehensive heart failure checklist to see how implementing such a tool can improve medication adherence and patient outcomes.
If broadly adopted, this checklist could translate into billions of Medicare dollars saved annually. While recent research has shown that proper patient education can reduce readmissions, this is the first study to test the use of a simple, discharge checklist that requires no extra cost to hospitals. For healthcare facilities aiming to optimize their cardiology programs, integrating this checklist could be a transformative step.
“Right now the checklist isn’t part of the standard medical record, so there could be resistance to using it,” Basoor said, “but if we show it’s really beneficial and easy to use, this could become a common practice. We’ve shown that quality of care can be improved at almost no additional cost. In the era of electronic medical records, we are working on transforming the checklist to an electronic form.”
Dr. Abhijeet Basoor, MD
The checklist was implemented after approval by the hospital’s Cardiovascular Quality Integration Board. In a randomized controlled trial, 96 patients were monitored for 6 months following an initial heart failure event. In half of these cases, physicians utilized the checklist, while the other half received standard discharge procedures.
Data collected 30 days and 6 months post-discharge showed significant differences. In the checklist group, only one patient was readmitted within 30 days compared to nine in the control group. At the 6-month mark, 11 patients in the checklist group had been readmitted versus 20 in the control group.
The findings from St. Joseph Mercy Oakland Hospital demonstrate the significant impact a simple, structured approach like a heart failure checklist can have on patient outcomes and hospital costs. By reducing 30-day readmission rates from 20% to 2%, this tool not only improves patient care but also helps hospitals minimize penalties and manage Medicare spending more efficiently. As healthcare systems face increasing financial and regulatory pressures, adopting evidence-based strategies such as this checklist is crucial for both patient safety and operational success.
For hospitals seeking practical and cost-effective ways to enhance heart failure management, implementing this proven checklist could be a transformative step. By integrating these interventions, healthcare facilities can reduce the burden of heart failure readmissions and promote better long-term outcomes for their patients.
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