Background: Heart failure is a main reason for hospitalization in those 65 years and older. Additionally, individuals with heart failure can experience frequent admissions, readmissions, and poor quality of life. A systematic review suggested that nurse-led patient education for adults with heart failure reduces hospital admissions and readmission. This quality initiative emphasized an interprofessional model of patient education, involving both heart failure nurses and residents.
Purpose: The goal of this quality initiative was to enhance patient understanding of heart failure through an interprofessional nurse-resident led heart failure education, with an emphasis on teach-back method. We hypothesized an improvement in rates of patient level of confidence and inclusion by 25% in one year after the educational sessions.
Description: This quality initiative took place at SUNY Upstate Medical University Hospital in Syracuse, NY, between July 2020 and August 2021. It was reviewed by the SUNY Upstate Institutional Review Board (IRB) and exempted under quality improvement project. Patients admitted to the hospital with a diagnosis of congestive heart failure (including systolic, diastolic, or combined) exacerbation were selected by heart failure nurses. The educational sessions were held weekly, depending on patient availability and ability to participate in an hour-long session. These sessions were led by a third-year internal medicine resident in collaboration with a heart failure nurse. Surveys were utilized to assess patient understanding of the disease, medications, dietary habits, and level of confidence and inclusion in decisions pre- and post-educational sessions. The Likert scale survey questions, developed on the principles of the Press Ganey patient experience survey, covered the above-mentioned domains. Data were analyzed using chi-squared test. Thirty patients have participated in the educational sessions over one year. Pre-intervention, 27% of patients noted their level of confidence in managing their heart failure as good or very good, compared to 90% of patients post-intervention. Pre-intervention, 57% of patients stated their level of inclusion in decisions about treatment plan to be good or very good, compared to 93% of patients post-intervention. There was a statistically significant increase in participants who rated their level of confidence in managing their heart failure and those who rated their level of inclusion as good or very good after the intervention (chi-squared statistic 24.8 and 10.8 respectively, p-value < 0.01).
Conclusions: The collaboration between heart failure nurses and medicine residents through these educational sessions has shown a statistically significant improvement in patients’ level of confidence and inclusion in decisions about their treatment plan. Although the number of participants is a limitation of this quality initiative, these results emphasize the importance of adequate patient education. Our future goal is to evaluate for any correlation between hospital re-admission rates for heart failure exacerbation before and after this educational intervention.