Heart failure is a growing problem in the U.S., with over a million hospitalizations, skyrocketing costs, and pressures to improve care. While many treatment options exist, heart failure is complex and we know that treating patients with medications, devices, and surgeries is simply not enough. But there’s some good news. Health systems, such as Intermountain Healthcare, are developing innovations to better educate and engage heart failure patients through simulation training.
Intermountain Healthcare’s Simulation Center recently piloted a heart failure simulation education program for patients at LDS Hospital and Intermountain Medical Center in Salt Lake City. The simulation includes the opportunity for a patient to practice their self-care behaviors in a realistic, home-like environment. The simulation concept is currently featured on display at the Kaiser Permanente Center for Total Health.
Why use simulation training for heart failure patients? Historically, heart failure patient education has been paper-based, passive, and usually done just before hospital discharge, leaving many patients unsure of how to follow their treatment plan. Few measures have been implemented to ensure that the learning has occurred, which increases the risk of ineffective follow-up and costly readmissions.
“Educating heart failure patients on how to live well with this chronic illness has long been a challenge,” says Kismet Rasmusson, nurse practitioner at Intermountain Medical Center Heart Institute, who has helped lead the simulation pilot project, funded by the Intermountain Foundry.
“We’re in a time in healthcare where the patient experience and engagement is so important,” says Kismet. “Patients expect high quality care and we need to deliver meaningful education to them. The simulation environment incorporates the hands-on, experiential side of adult learning, which is proven to be successful. It’s a great way for patients to translate the knowledge and self-care behaviors they’ve received into action they can follow at home.”
The pilot program is unique because simulation education hasn’t been used with heart failure patients before. However, simulation has a strong history in aviation training and has proven efficacy in healthcare to train clinicians. Providing an engaging training is a promising way to empower heart failure patients to follow the heart failure discharge guideline, which are known at Intermountain as the MAWDS-Heart Failure system (the acronym stands for medications; activity; weight; diet; symptoms).
What happened during the pilot? During Intermountain’s test pilot, patients practiced doing everyday activities like sorting medications, tracking trends of their blood pressure and weight, using a diary, and learning how to act on worrisome symptoms — often with a spouse or family member at their side. Trained clinical caregivers made observations and afterward met with the patient and their loved one to provide customized follow-up education.
The simulation takes place in a facilitated experience, and includes a debriefing, for patients to work through self-care activities to identify and overcome any barriers. This allows patients to then take charge of their care by creating plans that are meaningful and achievable in their individualized settings at home. The team is also testing a remote version of the program where patients participate in simulation from home through telehealth.
One pilot patient says, “The simulation made the whole thing seem real. It was an eye opener to imagine myself doing this at home so I can do the right thing. My husband wants to be more supportive as it opened his eyes as well.”
What are the results so far? The preliminary results show the test pilot has been positively perceived by patients. Nancy Bardugon, Intermountain Healthcare’s simulation director says, “Patients appear to have higher confidence in their treatment plan and greater satisfaction with their care — both of which align with Intermountain’s mission to help people live the healthiest lives possible.”
Based on the outcomes and the forthcoming results of the test pilot, the team hopes to expand heart failure simulation education and other patient-based simulation system-wide at Intermountain.