University of Colorado Hospital further cemented its position as one of the nation’s top nursing facilities this month with the selection of Colleen McIlvennan, DNP, MS, as a national Magnet Nurse of the Year. McIlvennan received the honor at the American Nurse Credentialing Center’s annual Magnet Conference in Orlando Oct. 6 for her work that focused on the decision to undergo surgery to implant left-ventricular assist devices.
McIlvennan, lead nurse practitioner for the Advanced Heart Failure and Transplantation team at UCH, was one of five nurses selected by the ANCC. She is the hospital’s third Magnet Nurse of the Year honoree in the past five years, following Tracy Anderson in 2011 and Samantha Weimer in 2013.
That’s a first, said Mimi Ryan, RN, MS, NE-BC, director of the Magnet Program at UCH. “We’re the only one with a hat trick.”
To LVAD or not LVAD
But the award is less about style points than substance. McIlvennan was recognized in the Empirical Outcomes category for exploring the beliefs of patients with heart failure deciding on whether or not to undergo surgery to implant left-ventricular assist devices, or LVADs. The patients she studied were considering the LVADs as “destination therapy,” meaning that they were not eligible for heart transplants.
Her work, for which she earned an American Heart Association “Young Investigator Award” in 2013, led to an eight-page pamphlet and 26-minute video that rely on the best evidence available to explain to patients and caregivers in straightforward, objective terms the pros and cons of getting an LVAD – or not.
For example, the data show that eight of 10 patients who receive a destination-therapy LVAD will survive for at least one year, while only two of 10 who forego the surgery will do so. On the other hand, getting an LVAD requires complex open-heart surgery and regular maintenance of the device, something not every patient will wish to do.
McIlvennan’s research also showed that the decision-making process among patients weighing LVADs differs. Broadly speaking, some look at the available evidence as objectively as possible, while others approach the decision more emotionally – deciding, for example, that pursuing every available life-extending treatment or technology is paramount, regardless of the risks.
The research continues. The decision aids paved the way for a $2 million grant from the Patient-Centered Outcomes Research Institute to fund a trial, led by UCH heart failure specialist Larry Allen, MD, that assesses how the aids are used in clinical practice. Six hospitals, including UCH, are part of the study. McIlvennan said patient enrollment will continue through January, followed by a year of data analysis. Through September, a total of 221 patients and 149 caregivers had been enrolled.
“The grant dollars are to help us test the decision aids and find the best ways to use them in clinical practice,” McIlvennan said. The idea is also to compare the decision aids with materials the hospitals currently use to explain LVADs to patients.
The ultimate goal, McIlvennan said, is to help patients “ground their decisions in unbiased information, derived from clinical data. They can see in the brochure and the video that the information comes from medical literature. The aids also help to save clinicians time in discussing these issues with their patients.”
The aids have strong clinical value, said Carolyn Sanders, RN, PhD, chief nursing officer for UCH. “We put so much emphasis on the decision-making of patients,” she said. “These tools are a way to help to truly inform patients so they can make decisions on their own.”
That need is likely to increase, McIlvennan said. She noted that a dozen or so institutions not involved in the trial have contacted her team about the decision aids.
“The biggest issue with LVADs is they are still relatively new,” she said. “It has been a small population of patients, many of them in clinical trials, who receive them, but now that is expanding. More patients are eligible and the therapy is more available.”
Ratcheting down readmissions
The ANCC also took into account McIlvennan’s work with many of her colleagues to reduce the hospital’s 30-day readmission rates for heart failure patients – a well-established goal of the Centers for Medicare and Medicaid Services. That effort aimed to improve identification of heart failure patients when they are admitted to the hospital and to develop order sets that providers across various service lines use to deliver targeted care.
The strategy includes using the Epic electronic health record (EHR) to flag lab values, medication orders and other clinical data that indicate heart failure. That, in turn, triggers a best practice alert in the EHR, suggesting that providers implement the order sets, specifically developed for heart failure patients, at admission and discharge.
The plan produced tangible outcomes, Ryan noted in her letter to the ANCC nominating McIlvennan. For example, 66.7 percent of patients at UCH discharged with a heart failure diagnosis received a follow-up appointment, compared with the national average of 54.4 percent. The 30-day readmission rate, at 20 percent, is still higher than the team would like, McIlvennan stressed, but it is lower than the 22 percent reported nationally.
“Heart failure is the disease state with the highest 30-day hospital readmission rate,” Sanders said. “The work that Colleen has been involved in has helped us manage patients appropriately, which affects those rates. That’s a value to patients and to us as a hospital.”
Spreading the credit
For her part, McIlvennan stressed that the successes are not hers alone. That’s illustrated by the “Hospital to Home” program, launched at UCH in 2010 to reduce 30-day readmission rates for heart failure patients. It brings together the skills of physicians, nurses, case workers, pharmacists, social workers, quality specialists and others to integrate and manage care and prevent unnecessary emergency department visits and hospital admissions.
The hospital also joined the American College of Cardiology’s Patient Navigator Program in January 2015. The three dozen or so participating institutions gather and benchmark data to improve care to patients with cardiovascular problems, including heart failure and heart attack. The emphasis again is on multidisciplinary care.
“I feel honored and humbled to be recognized, but it wasn’t just me. A lot of people have done great work,” McIlvennan said. “From the beginning, we’ve engaged many teams and sought their input for the best care of our patients and to prevent readmissions. That speaks a lot to the culture at University.”
It also helps to explain the hospital’s Magnet hat trick, Ryan said.
“We have a culture of curiosity here. It’s what sustains us and drives us toward excellence,” she said. “We’ve created processes that encourage nurses and providers to find the evidence that will help to improve patient care.”
McIlvennan’s achievement is impressive from both an individual and collective standpoint, Sanders added, in that her research and clinical practice help to move health care forward.
“When our providers do something so special that impacts patients’ lives, others want to learn more from it,” she said.