The use of integrated flowsheets in the electronic medical record in management of heart failure: a quality improvement project

Abstract

Background: Heart failure affects a large number of the population globally with expected increases in the coming years. Rural populations are at higher risk of developing heart failure with higher mortality and hospitalization rates as compared to urban populations, often related to social determinants of health. Interventions to improve adherence to medical therapy and increase efficiency are imperative to ensure individual providers are providing quality care to heart failure patients. Methods: A heart failure flowsheet was implemented in a private cardiology practice in North Central Montana. The flowsheet included aspects of heart failure management such as New York Heart Association class, medications, and standard cardiac evaluations with the hopes that the flowsheet would improve efficiency and adherence to GDMT. Results: Seventy-seven patients with heart failure or cardiomyopathy were evaluated during the implementation period. Of those, 88% had a flowsheet encounter created. Of those seen, 36% were on all four classes of medications. Six had additional medications added to their heart failure regimen. Important insights were noted regarding medication utilization, with 41% of those on less than four classes of medications having explicit reasons as to why. Providers and clinic staff recognized a subjective improvement in efficiency with flowsheet utilization. Conclusion: Implementation of the heart failure flowsheet provided invaluable information to the clinic and providers regarding heart failure management and improved efficiency. The results of the QI project will continue to guide the clinic in heart failure management and allow for further assessment of medication utilization and patient outcomes.