HA580 Unit 6 Same-Day Heart Failure Unit Proposal Example

Four Recliners Instead of a Hospital Bed: An Innovation Proposal for a Same-Day Heart Failure Diuretic Unit at a Composite Five-Hospital System, Tested Honestly Against Christensen's Account of Disruptive Innovation and Designed as a Six-Month Pilot

[Student Name]

Purdue University Global

HA580: Leading Health Care Transformation With Strategy Integration

Unit 6 Innovation Proposal

[Instructor Name]

[Date]

The system, the unit and every figure are composite and bracketed for the writer's own data; the research and framework cited are real, and clinical protocols would be set by the system's cardiologists.

The Need

Of the [690] visits, [41] percent began after [17:00], when the heart failure clinic was closed. Most patients arrived with weight gain and breathlessness from fluid buildup, often after several days of rising weight at home. Of those admitted, the median stay was [four] days. Clinic nurses reported that many of these patients had called during the day and been told to go to the emergency department because no same-day option existed.

The Model

A same-day heart failure unit inside the existing clinic, open [07:00] to [21:00] seven days a week, with [four] recliners. Staffing: [two] registered nurses per shift and a nurse practitioner on site, with a cardiologist available by phone. Patients enrolled in the clinic weigh themselves daily and call a nurse line when weight rises past a set threshold; the nurse books a same-day slot. In the unit, patients receive intravenous diuretics under a protocol written by the system's cardiologists, with laboratory tests before and after, and leave the same day; a nurse phones each patient the following morning. Patients who do not respond, or who show signs of serious illness, are admitted directly.

Evidence

In a hospital-based heart failure program, about [72] percent of patients treated with outpatient intravenous diuretics for decompensation stabilized without admission, with few safety problems (Ryder et al., 2008). The approach is established clinically; what is new for this system is offering it at the hours when patients actually decompensate. The treatment is old; what changes is where and when patients can get it.

What Patients Gain

For a patient with heart failure, an admission means hours waiting in the emergency department, a hospital bed, a risk of delirium or infection and often a decline in strength that lasts beyond the stay. A visit to the unit means a few hours in a recliner, often with a family member, and sleeping at home. Patients in the clinic's advisory group said the evening hours mattered most, because symptoms often worsen after a day of activity and they did not want to wait until morning or face the emergency department alone at night.

How the Unit Fits the Strategy

The unit serves three objectives on the system's strategy map: reducing avoidable admissions, building care capacity outside the hospital, and earning shared-risk revenue. It also gives the system practice in running a protocol-driven outpatient service, a capability it will need as more of its revenue moves to contracts that reward keeping people out of hospital.

Testing the Idea Against Disruption

Three enablers of disruption in health care frame this test (Christensen et al., 2009): a simplifying technology, a business model that can deliver it at lower cost, and a value network in which the parties benefit. Technological enabler: partly met. A standardized diuretic protocol and home scales turn a judgment that once required a hospital team into a rules-based process a nurse can run. But none of this technology is new. Business model: met. The unit is a focused process, treating one condition with one protocol, which fits Christensen's description of a value-adding process business rather than a hospital's open-ended problem-solving model. Value network: partly met, and only because of the contract. Under fee-for-service, the unit replaces admissions that pay the system far more than an outpatient infusion, the same perverse incentive that leaves hospitals better off financially when readmissions occur (Berenson et al., 2012). Under the insurer's shared-risk contract, avoided admissions produce shared savings. Unit 4 showed that at a [50] percent share, avoided stays at the system's own hospitals still lose money; the value network works fully only once the system bears downside risk.

Pilot Design

Duration: six months. Population: the [420] members enrolled in the heart failure clinic. Measures: share of unit visits ending without admission within [30] days; emergency visits and admissions for heart failure per hundred members; safety, including kidney injury and low potassium; and patient experience. Comparison: the same members' prior six months, and a matched group from a clinic without the unit. Decision rule: expand if at least [60] percent of unit visits avoid admission with no rise in safety events.

Cost

Staff, recliners, supplies and the evening nurse line: about [$610,000] a year. If the unit avoids [150] admissions a year, savings to the insurer are about [$1.8] million.

Risks

Patients may still go to the emergency department out of habit; enrollment teaching addresses this. Staffing evenings is harder than days. Cardiologists may differ on the protocol, which should be agreed before launch.

Conclusion

The unit offers a well-established treatment at the right hours. Whether it pays depends less on the idea than on the contract the system signs.

References

Berenson, R. A., Paulus, R. A., & Kalman, N. S. (2012). Medicare's readmissions-reduction program: A positive alternative. New England Journal of Medicine, 366(15), 1364-1366. https://doi.org/10.1056/NEJMp1201268

Christensen, C. M., Grossman, J. H., & Hwang, J. (2009). The innovator's prescription: A disruptive solution for health care. McGraw-Hill.

Ryder, M., Murphy, N. F., McCaffrey, D., O'Loughlin, C., Ledwidge, M., & McDonald, K. (2008). Outpatient intravenous diuretic therapy: Potential for marked reduction in hospitalisations for acute decompensated heart failure. European Journal of Heart Failure, 10(3), 267-272. https://doi.org/10.1016/j.ejheart.2008.01.003