The Fuqua Heart Center developed the new model in record time.  In five months, they developed the clinic and established the clinical protocols for treating heart failure patients.  In addition, the Heart Failure Resource Center (HFRC) staff developed and provided the hospital staff with advanced heart failure specific education.  The medical directors promoted the program to the medical staff through presentations at department meetings.

The Fuqua Heart Failure Resource Center currently staffs 1.5 FTE Nurse Practitioners and is in the process of recruiting an additional two NPs.  In addition, clinic staff includes a Clinical Nurse Specialist and a staff RN. Plans for the immediate future include the addition of clinical support staff that will allow more time for the clinicians to focus on patient care.  For all clinical positions, HFRC recruits individuals with cardiovascular experience.

As part of its ongoing nursing staff education plan, Fuqua tries to provide at least two educational offerings to all staff specific to heart failure per year.  In addition, Fuqua encourages continuing education for all clinic staff.

Patients can be referred to the HFRC program in three ways.  The majority of patients come from the inpatient setting, where physicians refer the patient as part of the discharge plan.  A clinic appointment is scheduled 10 to 14 days after the hospital discharge, and the discharge instructions tell the patient to call the clinic if they have any questions or issues prior to their appointment.

In addition, emergency department providers can refer heart failure patients to the clinic during clinic hours.  Finally, physician offices refer patients to the program.

The Fuqua Heart Failure Resource Center has hosted site visits from multiple organizations from across the country interested in potentially implementing a similar care delivery model.  In addition to observation of the physical space, the programs include discussion on how to implement this type of care delivery model, education methods for patients and staff, and business case methodologies.

The HFRC’s unique care delivery model has the potential for broad replication by community hospitals treating large numbers of heart failure patients.  Hospitals face a clear incentive to reduce readmissions for this population as Medicare does not offer reimbursement for readmissions within 30 days of discharge for CHF. 

A similar program might also work well for patients with other chronic diseases such as diabetes, asthma, and COPD.