Case management for heart failure in the emergency department.

Heart failure affects approximately 5 million individuals in the United States and is the most common discharge diagnosis among the elderly. The number of individuals diagnosed with heart failure will continue to rise as the population of the United States ages. The natural course of the disease is characterized by periods of stability interrupted by periods of symptom exacerbation. These periods of exacerbation often require emergency intervention or hospitalization for management. Once an individual is hospitalized, they are at a greater risk for rehospitalization. The causes of rehospitalizations are multifactorial and many are preventable. Case managers are in a position to have a positive impact on the readmission rate. Interventions include adherence to medication guidelines, increasing patients' knowledge of self-care measures, assessing discharge readiness and needs, and increasing the frequency of symptom monitoring for early intervention. Case management begins in the emergency department and facilitates care throughout the patient's stay by fostering communication among all caregivers and the patient and family. Case managers also affect the quality of care patients receive by instituting processes that streamline care and ensure that quality care is provided to the patients. They also serve as mentors and resources for other members of the healthcare team. Most of the information about case management comes from inpatient and outpatient programs; however, the emergency department nurse can adapt these models to support their role. More research is needed as to what specific portions of the case manager's role are most appropriate for the emergency department.