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Hospital with lowest heart failure readmissions tells how it’s done

May 14, 2017

As a rule, people with heart failure cycle in and out of hospitals regularly, losing a little ground and racking up big bills each time.


But Lancaster General Hospital is bucking that trend, with the lowest Medicare heart failure readmission rate in the nation over the most recent three-year period measured.

Hospital leaders say that’s due in large part to a heart failure program started close to two decades ago.


Program director Dr. Justin Roberts says the condition is common among older people, and serious, with an average life expectancy of about five years once it’s diagnosed.

But patients don’t always realize that, as hospital treatment eases painful symptoms including shortness of breath.


“People think if I’m in the hospital I’m getting fixed,” said nurse practitioner Lisa Rathman, who helped start the program. “Nothing is ever fixed for these folks, unfortunately.”


So the program works hard to educate patients, with lots of personalized attention as they explain why it’s vital to follow an extremely low-salt diet, take the array of medications correctly, and monitor weight daily.


“We talk to people very quickly after they leave the hospital,” Rathman said. “Most people say, ‘You just saw me three days or a week ago, why do you need to see me already?’


Her answer, she said, is that one in four heart failure patients nationally are back in the hospital within a month after being discharged.


The team’s ability to form a strong relationship with patients is a key to its success, Rathman said, and Lancaster General’s work to make everyone from social workers to dietitians to case managers available to high-risk patients who have difficulty traveling to appointments helps a lot too.

Many heart failure patients have other serious conditions as well, Rathman said, so it’s not uncommon for them to be prescribed 20 to 25 medications a day — a challenge for anyone to keep track of, especially given that up to a quarter of them are cognitively impaired to some degree.


Vince Parelli, 70, of Manheim Township, has spent a lot of time with the program in the past few years, very little of it in the hospital.


He needed a pacemaker and felt instantly better after he got one, Parelli said, but thanks to the clear explanations knows that it’s important that he be involved in actively managing the disease.


For instance, he said, he didn’t like all the pills he was taking, so he talked to his doctor and was able to be weaned off one — but is okay taking the rest because the doctor said they’re essential to his survival, and he believes it.


“I hug my doctors,” he said, easily rattling off their names and the names of the nurses he interacts with regularly. “These people saved my life.”


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