Multidisciplinary Assessment to Personalize Length of Stay in Acute Decompensated Heart Failure (OPTIMA II ADHF)

Frank Dusemund, Martin Steiner, Andre Vuilliomenet, Christian Muller, Rita Bossart, Katharina Regez, Ursula Schild, Antoinette Conca, Andreas Huber, Barbara Reutlinger, Beat Muller, Werner C. Albrich

Abstract


Background: Acute decompensated heart failure (ADHF) causes a substantial burden for health care systems. Data to rationally define the need for hospitalization or the appropriate length of stay (LOS) is limited. Our aim was to personalize length of stay in patients admitted to hospital for acute decompensated heart failure.

Methods: Consecutive patients with ADHF presenting to our emergency department were prospectively followed. We daily conducted a multidisciplinary risk assessment and compared proposed with actually observed triage decisions.

Results: At presentation, all patients required hospitalization. Median LOS was 11 days including 1 day after reaching medical stability. In 42.7% of patients, hospitalization was prolonged after medical stability mainly for nursing and organizational reasons. Within 30 days of enrollment, 7 (9.3%) patients were rehospitalized, 3 of them for persisting or relapsing heart failure.

Conclusions: There appears to be potential to shorten inhospital stay in patients with ADHF mainly by providing post discharge ambulatory nursing care in order to improve resource utilization and to diminish hospitalization-associated disability.




doi: http://dx.doi.org/10.4021/jocmr1154w


Keywords


Acute decompensated heart failure; Triage process; Biopsychosocial assessment; Length of stay; Hospital-associated disability

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