Anyone do Transitional Heart Failure??

  1. Okay - so I accepted a new job at a large (900 bed+) hospital heart failure transitional care center. The goal is to keep these pts out of the hospital and decrease readmission rates.

    Its a growing program.

    We see pts in-pt and then see/follow them up as outpts, caring for them thru the first 30 days post-admission.

    Anyone do anything like this??
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    About traumaRUs, MSN, APRN, CNS Admin

    Joined: Apr '00; Posts: 53,006; Likes: 25,756
    allnurses Asst Community Manager, APRN; from US
    Specialty: 25 year(s) of experience in Nephrology, Cardiology, ER, ICU


  3. by   WestCoastSunRN
    I have no personal experience with this sort of program, but just want to say Congratulations! It sounds like a VERY cool program. Dare I say.... it sounds dreamy, actually -- but I do like hearts and have a soft spot for those with HF. Please let us know how it goes.

    And best wishes to you on this new endeavor.
  4. by   juan de la cruz
    How exciting, congratulations. I've heard of a similar job description for an NP when I worked in the Midwest. When I was a bedside nurse, I also know of a CNS that did that but she didn't prescribe or anything but did a lot of patient education, phone triage, symptom monitoring, and referrals to the appropriate medical services for the patients assigned to her service. Sounds like a great opportunity to make a difference in the lives of people with heart failure.
  5. by   ManicMommy123
    Enjoy, I hope you like it! I work with lots of cardiac patients, so sometimes I moonlight in the HF clinic. That population needs lots of attention!
  6. by   Bumex
    That sounds amazing. I always loved treating heart failure- such a dynamic disease process. Good luck!
  7. by   traumaRUs
    Thanks everyone - will be nice to have a hand in further developing this program. The hospital is looking to restart a heart transplant program too...
  8. by   BCgradnurse
    Congrats! It sounds like a great position. No more driving hundreds of miles a week!
  9. by   ghillbert
    Congrats - sounds great! I work on the other end with CTICU heart failure patients when they get LVADs etc. They certainly have a high burden of care in the community and so many meds to keep up on etc - sounds like an awesome program you will be starting.
  10. by   CardioDNP24
    Hi there!
    If you ever need any help or advice for TOC and HF please feel free to send me a message. My dissertation was on TOC and HF and the creation of a novel new model for HF TOC.

    Good luck!!!
  11. by   traumaRUs
    Thanks so much CardioDNP - appreciate the offer.