(CCSP070) IMPLEMENTATION OF A SPECIALIZED HEART FUNCTION INPATIENT UNIT TO OPTIMIZE PATIENT CARE AND STAFF/LEARNER SATISFACTION

Background: Hamilton General Hospital (HGH) is a tertiary care centre that provides regional cardiovascular care to a population of 1.8 million in the Southwest region in Ontario. Approximately 2/3 of all patients admitted to the non-critical care cardiology inpatient services have a diagnosis of heart failure (HF), a complex condition with the longest length of stay (LOS) and highest readmissions. The current services at HGH are unable to accommodate the growing number of complex HF patients. Therefore, a new specialized HF inpatient unit was implemented in October 2022 to optimize patient care, improve work satisfaction for staff and educational opportunities for learners, and decrease LOS and hospital readmissions.

METHODS AND RESULTS: The new HF inpatient unit has flexible capacity of 7-10 beds and is staffed by a cardiologist and nurse practitioners who are specifically trained in the management of HF. Online surveys were administered at 3-months post-implementation to all staff involved in the new HF inpatient unit (7-point Likert scale: 1=strongly disagree;7=strongly agree). Surveys were informed by the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). In addition, patient metrics for 6-months pre-implementation and 4-months post-implementation were evaluated from the Discharge Abstract Database housed in the HGH’s electronic medical records, including LOS and 30-day readmission rates.

The response rate was 86% for physicians (n=14), 37% for nurses (n=51), and 100% for learners (n=7). At 3-months, staff were very satisfied with the new HF inpatient unit, with mean Likert scale responses of 5.45 (SD=0.93), 5.55 (SD=1.04), 5.58 (SD=1.77), respectively. When asked how successful they feel the new heart function unit is in increasing the quality of transitional care (bridging inpatient to outpatient services), all groups had a mean Likert score of 5.79 (SD=1.06). Cardiology inpatients with a primary diagnosis of HF in the pre-implementation period (n=111) were compared to patients in the post-implementation period (n=82). While not significant, there was a trend for improved median LOS (8.3 days, IQR=0.75 vs. 7.9 days, IQR=1.6, Z=-0.32, p=0.74) and readmission rate (21% vs 15%, t(7)=1.71, p=0.13) in the post-implementation group.

Conclusion: Preliminary evaluation of a new specialized HF inpatient unit indicates it has been well received. Feedback surveys have noted a smooth transition between inpatient and outpatient care. Furthermore, since the implementation, data suggest a (non-significant) trend towards reduced LOS and hospital readmissions. Repeat surveys at 9-months and administrative data analysis at 12-months post-implementation will be undertaken.