Thursday, April 17, 2008

Identifying heart failure from the get-go

This paper in the Journal of Hospital Medicine is more about the administrative diagnosis of heart failure than it is the clinical diagnosis. So is it even worth reading? Perhaps, but more for the clinical documentation specialists and core measure folks than for the clinicians.

How often have you seen this: The patient presents to the ER. Somebody casually mentions heart failure. Maybe the admitting doctor adds it to the differential diagnosis. The core measure team and clinical documentation specialists spring into action and clutter the chart with prompts and reminders. Come discharge time the patient, who turned out to have an exacerbation of COPD, not heart failure, is confused. She wants to know why a stranger came and told her to weigh herself every day, and what she’s supposed to do with the ream of paper on heart failure left on her bedside table. Or what about the patient whose correct diagnosis of heart failure was documented late in the admission resulting in a rush to comply with the core measures and the info packet being dropped in her lap as she’s wheeled out the door?

The paper presents a simple tool to help predict early on which patients will end up with a discharge diagnosis of heart failure. Show it to your core measure people. Maybe it’ll help.

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