Optimizing Heart Failure Management: Development and Implementation of a Standardized Discharge Checklist for Heart Failure Patients in a Tertiary Care Hospital in Pakistan

Quality Improvement Project (QIP)

Abstract

Background: Heart failure (HF) is a major contributor to hospital admissions, mortality, and healthcare costs globally, particularly in low- and middle-income countries such as Pakistan. Despite the availability of evidence-based guidelines from the European Society of Cardiology (ESC 2023) and NICE (NG106), their implementation in routine clinical practice remains inconsistent. In many tertiary care hospitals, discharge processes are fragmented, lacking standardized documentation, optimal therapy, and structured follow-up, leading to high rates of 30-day readmissions and poor outcomes.

Objective: To develop and implement a structured discharge checklist to standardize care, improve guideline adherence, and reduce early readmissions in HF patients.

Methods: This quality improvement project used the Plan–Do–Study–Act (PDSA) methodology. A retrospective baseline audit was conducted from July to August 2024, including 125 patients admitted with heart failure. A standardized discharge checklist based on the 2023 European Society of Cardiology (ESC) and NICE NG106 guidelines was implemented during PDSA Cycle 1 (10–24 September 2024) in 28 patients. Baseline and post-intervention outcomes were compared using the chi-square test.

Results: Significant improvements were observed in documentation of HF type (59.2% to 85.7%), NYHA class and LVEF (52.8% to 82.1%), and GDMT prescription (40.8% to 67.8%). Patient education improved from 31.2% to 60.7%, and follow-up planning within 14 days increased from 37.6% to 78.5%. Communication with primary care providers improved from 26.4% to 57.1%. The 30-day readmission rate decreased from 33.6% to 25.0%.

Conclusion: A standardized discharge checklist significantly improved discharge practices and demonstrated early potential to reduce readmissions. This low-cost intervention is feasible and effective for improving HF care in resource-limited settings