Year: 2018
Type: editorial
Abstract: s the epidemic of heart failure (HF) in the United States continues to grow, so, too, does the associated financial burden imparted on patients, caregivers, and our healthcare economy.Among other metrics, length of stay (LOS) and 30-day risk-standardized readmission rates are frequently used as important benchmarks by which to judge success in the care of patients hospitalized for acute decompensated HF.Despite the fact that the decision of when to discharge a patient from the hospital can directly impact these metrics, 1 there is a paucity of evidence-based recommendations that exist to standardize the process of evaluating and declaring patients ready for discharge from the hospital after admission for HF. 2 Because of this lack of standardized metrics for what constitutes a clear hospitalization end point, clinicians vary markedly in factors that influence their clinical decision-making and their own personal thresholds for hospital discharge.It is on this background that Bhatt et al 3 have conducted a novel study in an attempt to understand, on a more granular level, the association of providerspecific decision-making in discharge preparations and outcomes in patients hospitalized for HF.In their single-center study, the authors first completed qualitative interviews with physicians inquiring about inpatient HF management practice patterns to identify common factors used by clinicians to gauge discharge readiness.Using this information, a 10-question survey with Likert-style responses was created and administered to 58 cardiologists and hospitalists who had frequently cared for patients hospitalized for HF during the prior year.The goal of the survey was to elicit individual responses on how various patient factors influence the decision of timing of hospital discharge.The survey items are generalizable into broad categories, such as resolution of symptoms, normalization of physical examination and laboratory abnormalities, and initiation of appropriate guideline-directed medical therapy.Physician-specific LOS and 30-day readmission rates during a 1-year period were abstracted retrospectively.The investigators then went the extra step to perform correlation tests to explore associations between importance placed on particular discharge readiness factors, per individual survey responses, and provider-specific median LOS and 30-day readmission rates.The goal was to tie together what a clinician thought about discharge readiness with real-world outcomes.The authors observed that the relative importance placed on a variety of clinical factors used to determine if a patient is ready for discharge varies from one clinician to another.Furthermore, certain inpatient HF discharge practice patterns were associated with decreased median LOS, but none were associated with differences in readmission rates.
Authors: Timothy J. Fendler, Shannon M. Dunlay
Institutions: Saint Luke's Hospital, Mayo Clinic
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2907322301