Increasing Palliative Medicine Presence in Heart Failure Admissions

Abstract

The Palliative Medicine team at a 182-bed hospital in a suburban area desired to grow its presence in the heart failure population by increasing consultation rates. A DNP project created at the site included the Palliative Medicine team, telemetry unit staff, and a quality improvement team. Using a Palliative Medicine Screening Tool for Heart Failure (PM-HF) by the nursing staff and overnight admission review by the group’s nurse coordinator, heart failure admissions were screened for potential needs. During the implementation process, sixty-four patients were reviewed by unit staff and sixty-three were reviewed by the Palliative Medicine nurse coordinator. Eighteen consultations were obtained from the 127 total reviews. Compared to the previous 6-month period prior to implementation, the Palliative Medicine team improved 19.8% regarding involvement in heart failure-related admissions. Due to the COVID-19 pandemic that occurred during project implementation, overall Palliative Medicine consultations for all diagnoses decreased by 1.3%. This project served the Palliative Medicine team and the hospital by highlighting gaps in delivery of heart failure-related care and opportunities for increased Palliative Medicine involvement. The PM-HF tool can be modified to include other diagnoses for future study and hospital quality improvement staff are reviewing ways to impact heart failure care based on this project’s findings. The addition of a Heart Failure Navigator to hospital staff would assist in providing excellent education and support for patients as well as encourage early identification of patients admitted with heart failure that have Palliative Medicine needs.