Background: As hospitalists we manage patients with a wide range of problems and an unplanned hospitalization might be the patient’s best opportunity to establish a healthcare connection. While our primary focus is stabilizing the patients and optimizing them for discharge, there is a significant opportunity to improve the quality of care they receive and enhance our own adherence to evidence based guidelines. For instance, ensuring that all appropriate GDMT (guideline directed medical therapies) are prescribed for patients with HFrEF (heart failure with reduced ejection fraction) in addition to diuresing to euvolemia and getting them home. Lapses in adherence to evidence based practices can lead to fragmentation of care, higher readmission rates, and exacerbation of health disparity gaps. These challenges are very salient for patients with congestive heart failure who often present with complex medical histories, comorbidities, and a variety of impacting social factors.
Purpose: A checklist smartphrase was integrated into discharge summaries to serve as a reminder to the discharging provider that evidence-based therapies were prescribed for the associated diagnosis (i.e., SGLT-2 inhibitor for HFpEF patients), and key information for outpatient teams (such as discharge weight for CHF patients) were documented. The smarphrase implementation began in November 2024 among teams staffed by advanced practice providers (APPs) in the hospital medicine division, which served as the intervention group. The control group comprised of non-APP-staffed general medicine inpatient teams in the same hospital. Quality metrics such as GDMT prescription rates and readmission rates, were tracked from July 2024 to April 2025.
Description: A total of 563 admissions were reviewed, with 334 in the control group (comprising 175 HFrEF diagnoses and 159 HFpEF diagnoses) and 229 admissions (comprising 123 for HFrEF and 106 for HFpEF) in the intervention group. The timeframe of the intervention was divided into three phases: the pre-intervention period (Jul. – Oct. 2024), intervention period (Nov. 2024 – Jan. 2025), and post-intervention period (Feb. – May 2025). During the intervention period, weekly reminders were sent to the APP groups on service that reach Monday to nudge them to use the checklist. Among HFpEF intervention teams, readmissions dropped significantly and remained lower during the intervention. Among HFrEF discharges, the intervention group also saw a significant drop in readmission from pre- to post-intervention. Among HFrEF patients, SGLT-2i prescription rates increased from pre- topost-intervention for both control (29.17% to 40.28%) and intervention (31.43% to 33.93%) groups. Among HFpEF patients, SGLT-2i prescription rates increased from pre- to post-intervention for the intervention group (9.09% to 18.60%) but decreased for the control group (18.52% to 16.98%).
Conclusions: Implementation of the discharge checklist was associated with improved clinical outcomes, particularly reduced 30-day readmission rates for both HFpEF and HFrEF, and improvements in adherence to GDMT medications in the intervention group. These findings support the effectiveness of the checklist intervention as a tool for enhancing heart failure discharge care. Future work is aimed to assessing whether this intervention is sustainable and to design similar effective smart phrases for other common conditions seen by hospitalists.