Reducing Short-Stay Heart Failure Admissions Through an Emergency Department–Initiated Rapid-Access Diuresis Program

Short stay (<2 days) hospitalizations for heart failure (HF) exacerbations increases costs, strain inpatient capacity, and expose patients to avoidable hospital-associated risks. Our objective was to evaluate the operational impact and safety of a standardized, ED-initiated rapid-access diuresis program designed to reduce short-stay HF admissions.

In April of 2024, a standardized ED-initiated referral program was implemented linking eligible patients to a rapid-access HF diuresis clinic. Hemodynamically stable, volume-overloaded HF patients were identified using standardized eligibility criteria, received initial stabilization and IV diuresis in the ED, and were referred directly for expedited outpatient follow-up. Key drivers included standardized patient selection, EM–cardiology collaboration, and EHR-integrated referral workflows. Outcomes included short-stay HF admissions (<2 days), referral capture rates, safety events, and estimated inpatient bed-days (based on median LOS of HF admissions) avoided from April through October 2024.

During the study period, 101 short-stay HF admissions occurred. Forty-seven patients (46.5%) met eligibility criteria for rapid-access diuresis clinic referral. Clinicians referred 27 of 47 eligible patients (57.4%; 95% CI 43.3%–70.5%), corresponding to an estimated avoidance of 49 inpatient bed-days based on median LOS of short-stay HF admissions. These referrals represented 26.7% of all short-stay HF admissions (27/101). Referral capture increased from April through Oct. 2024, suggesting improving clinician adoption. No ED 72-hour revisits or adverse events were observed among referred patients. Twenty eligible patients (42.6%) were not referred, highlighting opportunities to improve referral adoption.

Implementation of a standardized ED-to-outpatient diuresis care model improved transitions of care while creating potential inpatient capacity. By providing ED clinicians with a reliable and safe post-discharge pathway, short-stay HF admissions may be avoidable. Ongoing efforts focus on improving referral reliability and expanding the model across additional ED sites.