This improvement story originally appeared in IHI's 2004 Progress Report.
Hackensack University Medical Center (Hackensack, New Jersey, USA) has dramatically reduced heart failure readmission by implementing telephone follow-up with patients.
New technology routinely enhances the quality and effectiveness of diagnosis and treatment. But sometimes putting old technology to new uses can be just as effective, and more efficient.
Clinical staff at Hackensack University Medical Center (HUMC) in New Jersey, participants in the Pursuing Perfection program, an initiative of The Robert Wood Johnson Foundation for which IHI is the National Program Office, are using the telephone to follow up on heart failure patients after they’ve been discharged. Keeping clinical tabs on patients by phone is not only efficient, it is also effective. Since implementing the telephone follow-up program (TFP), readmission rates for heart failure patients have dropped by 78 percent. Fewer readmissions mean that staff and other resources are used more appropriately.
Tapped to run the TFP, nurses Michelle Browning and Tami Azouri launched an internal publicity campaign aimed at getting physicians to enroll their patients in the program. “We started with discharge planners,” says Browning, “then attended rounds on the primary cardiac floors, and put announcements in all physicians’ mailboxes. We also called them directly when we found patients on rounds we thought might be appropriate for TFP.”
Browning and Azouri use a computer program they helped develop to collect patients’ data and to help them track specific health indicators from patients at home, such as weight, swelling, shortness of breath, pain, appetite, and activity level. Through regular contact they can monitor patients’ needs and communicate with their physicians if there is an indication that medications should be adjusted.
“This is a big culture shift for our doctors,” says Browning. “It’s such a big hospital that many of the doctors don’t know us, and it is a leap of faith for them to trust us with their patients. But they are growing more comfortable with it as they begin to see the program’s value, and their patients are telling them how much they like it. Change like this takes time.”