Md Mahamud Hasan
East Kent Hospitals University NHS Foundation Trust, UKPresentation Title:
Shortened hospital stay and Improvement of inpatient management for Decompensated Heart Failure patients
Abstract
Introduction: Heart failure constitutes a pandemic health condition that is distinguished by its association with high morbidity and mortality statistics. Acute heart failure episodes necessitating hospital admission are characterised by poor clinical outcomes and increased hospitalisation duration, particularly within the context of an ageing demographic. While standard therapeutic regimens encompass IV diuretics, ARNIs (angiotensin II receptor blockers and a neprilysin inhibitor), beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 (sodium-glucose cotransporter-2) inhibitors, insufficient monitoring and modification of clinical and biochemical indicators contribute to extended hospital stays and increased adverse event rates.
Objectives:
• Reduction of acute complications (such as AKI, electrolyte imbalance, etc.) related to heart failure medications (IV diuretics).
• Shorten hospital stay.
• Less chance of developing hospital-acquired infections.
• Good quality of life.
Methodology: A retrospective review was conducted on electronic patient records from 50 individuals in the Elderly and General Medical wards. The bicyclic investigation of subjects with acute heart failure decompensation implemented comprehensive surveillance protocols featuring daily weight documentation, fluid equilibrium parameters, serial biochemical analysis of renal markers and electrolytes, and systematic fluid intake/output recording. The research focused on the emergence of complications, length of hospital stays, and adherence to monitoring protocols alongside standard care pathways. The initial cycle enrolment criteria encompassed patients admitted to general medical or frailty wards who received intravenous diuretic therapy for at least three days. A comprehensive review of medical documentation was conducted for the qualified patient population to obtain data concerning the degree of clinical supervision and the prevalence of adverse outcomes. Complications encompassed AKI, characterised by an increase in creatinine above the normal limit, and electrolyte imbalance, which involved sodium levels outside the range of 130-150 mmol/L and potassium levels outside the range of 3-5.5 mmol/L. Concurrently, we obtained perspectives from a representative sample of physicians and registered nurses regarding barriers that impede optimal monitoring protocols for heart failure patients. Subsequent to the initial data collection phase, we launched our intervention by installing poster displays that reinforced the clinical standards expected in acute decompensated heart failure care. The project team conducted instructional seminars for certain wards. The subsequent data collection phase employed comparable enrolment criteria for the second cohort.
Results: After interventions, we were able to demonstrate improved results compared to the initial cycle. Target fluid balance improved from 47% to 77%, daily weight from 17% to 43%, strict Intake-output charting 40% to 58%, daily U&Es 81% to 78%, and incidence of AKI 55% from 40%. Interestingly, the length of hospital stay was reduced by 2-3 days between two cycles.
Conclusions: Following strict monitoring protocols reduced complications, and shortened hospital stays for decompensated heart failure patients. Our trial revealed that this patient cohort was inadequately monitored. Insufficient staff awareness, increased workload constraints in healthcare settings, and accelerated patient discharge patterns were among the obstacles that contributed to these findings. Specific standard metrics were enhanced following a little awareness effort. There remains potential for advancement in several domains. It is unlikely that educational programmes alone will provide comprehensive solutions to all identified challenges. Ongoing advancement is expected to arise from further phases of research employing interventions such as electronic dashboard systems, streamlined procedures, and enhancements in monitoring efficiency.
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