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Heart failure (HF) is a syndrome of shortness of breath and fatigue. It occurs when forward flow of blood out of the heart is impeded. This is the only cardiovascular condition that continues to increase in prevalence and incidence. It is a major healthcare problem, not only for the patient, but also for significant others and the community at large. The condition accounts for approximately 12–15 million office visits and 6.5 million hospital days annually in the United States. One third of those discharged from the hospital are readmitted within 90 days because of recurrence of symptoms. The cost of HF patient care is approximately $38.1 billion annually, draining limited resources of patients, treatment facilities, and society.1–,3
Type of evidence used
To effectively deal with the problem of high HF admission rates and with the associated high number of days of hospitalisation, costs per case, and recidivism,1,4–,7 Jersey Shore Medical Center staff used a multidisciplinary approach in developing an HF centre. Evidence was retrieved from medical, nursing, and allied health literature. Existing HF centres were observed as well.
Method used to obtain and review evidence
The project manager and a physician who strongly supported the development of an HF centre visited several model HF centres in the United States. They spoke with experts in the field and gathered many ideas. Literature was reviewed to determine a “best fit” design for the planned facility.4–5,8–,12 A decision was made to have a physician directed, advanced practice nurse run centre to best serve the needs of the physicians with whom we work, and the community we treat. A decision was also made to hire an experienced advanced practice nurse (APN) with a broad cardiology background.13 The APN would run the HF programme based on guidelines developed by the project manager …
Footnotes
In 2001, the Honor Society of Nursing, Sigma Theta Tau International and Nursing Spectrum sponsored an “Innovations in Clinical Excellence” contest to recognise exemplars of evidence-based nursing practice. The following are 2 of the winning entries.
Reprinted with permission of the Honor Society of Nursing, Sigma Theta Tau International from Crowther M, Maroulis A, Shafer-Winter, et al. Evidence-based development of a hospital-based heart failure center. Online J Knowl Synth Nurs 2002;9:5C.