Cardiac Connection: Virtual Nurse Utilization for Heart Failure Readmission Reduction

Abstract

Heart failure (HF) is a leading cause of hospital readmissions, resulting in increased patient morbidity and financial strain on healthcare systems. This quality improvement project aimed to reduce 30-day readmissions for HF patients by integrating virtual nurses (VNs) into the discharge process to provide standardized education and schedule timely follow-up appointments. Conducted in a progressive care unit of a community hospital in central North Carolina, the intervention employed the Plan-Do-Study-Act (PDSA) framework to implement and evaluate the new process. Pre- and post-intervention data were collected and analyzed to assess utilization of VN services, appointment scheduling, and readmission rates. During the four-month implementation period, readmission rates declined from 20% to 16.7% overall, and to 18.2% when excluding patients discharged to skilled nursing facilities, those leaving against medical advice, or those who expired during the admission. Despite lower-than-expected VN utilization (19.4%), findings support that VN led discharge education and timely follow-up appointments can positively influence readmission rates. This project demonstrates the feasibility and impact of VN integration as a scalable and sustainable strategy for improving care coordination among HF patients.