21 Communication difficulties in the care pathway of patients admitted to hospital with acute decompensated heart failure. (28th September 2016) - Walshe, M
Abstract : Effective management of any chronic illness requires effective communication between all involved in delivering and receiving care. Central to this is effective inter-personnel communication and access to medical records. Heart failure (HF) care in particular demands good communication given the complexity of the illness and the tendency towards poly pharmacy. Method: In an ongoing study defining the care pathways of patients admitted with ADHF (Acute decompensated HF) (de novo presentations, DN; and known HF patients, KHF) we assessed specific features of communication along the care pathway: availability of HF records on Emergency Department (ED) presentation and clinically stable natriuretic peptide (NP) level and weight record for KHF patients. Confirmation of self-care education of DN patients was also assessed, as was education of DN relative or carer, including frequency of sessions for both. In addition, availability of medication lists on presentation, and confirmation of discharge information communications to GP and community pharmacist for all patients, were examined. Population: Eighty eight patients admitted to hospital with ADHF: 52.2% (46) DN, 47.7% (42) KHF, mean age 76 years, with a mean of 5 co-morbidities. Results: Of 88 patients followed 21 bypassed the ED. Of the 67 who attended the ED 43.2% (28) were KHF. HF records were available for 39.2% (11); NP during clinical stability was available for 28.5% (8) KHF, no NP on record for DN. Weight records were available for 21.4% (6) of known patients. Medication lists were available in ED for 38.8% (26) of all patients; Eighty-eight% (37) of the DN patients received education; of these 29.7% (11) received 1 session and 70.27% (26) received 1–3 sessions. 35% (15) relatives or carers received education with 46.6% (7) receiving 1 session and 53.3% (8) receiving 1–3 sessions. No prescriptions were faxed to community pharmacists, and 73.75% (59) patients discharged had letters sent to GP. Conclusion: This data highlights the communication difficulties present at various points in the care pathway of patients admitted to hospital with ADHF. Improved data access and inter-individual communication is necessary system-wide, to optimise management of HF patients.