Interview with Pamela Hall, RN, MBA, Executive Director

Interview with Pamela Hall, RN, MBA, Executive Director,

Athens Regional Home Health, Athens, Georgia

Home Health Agency Sees Immediate Success with ZOE®

Conducted December 17, 2008 by Carolyn Humphrey, RN, MS, FAAN

CH: Tell me about your decision to use the ZOE® Fluid Status Monitor

PH: Our agency is hospital-based and is 10 years old this month. We have an average daily census of 160 and have 31 employees. We’re Medicare Certified and Joint Commission accredited. Like most home health agencies, we have a large number of patients with heart failure (HF).

We have a cardiac program in the agency and have implemented a Disease Management (DM) program for HF that is built onto the hospital’s inpatient program. Once the patient is discharged from home health, they go to the hospital’s telephonic program.

For our cardiac program we researched best practices, used the American Heart Association (AHA) and Institute for Health Improvement (IHI) web sites and clarified what a Heart Failure/Disease Management program should be. We thoroughly researched the ZOE®, beginning in January, 2008. We wanted to have our “ducks in a row” before we got started.

CH: You started using ZOE® Monitors less than two weeks ago, how are things going?

PH: We decided to rent 10 ZOE®s since we wanted to try them out before we purchased them. In November we had one ZOE® Monitor in the agency to orient clinical staff. We went “live” using the ZOE® on December 9th.

Our nurses have already seen benefits. Our first patient had a long history of HF. Although she wasn’t in and out of the hospital as much as some of our other patients, she needed close monitoring. On our first visit to her with the ZOE® Monitor however, she would have been admitted to the hospital if the ZOE® didn’t allow us to catch the problem with her diuretic medication.

The nurse had established the patient’s baseline Zo at 28.6. The next day it was 29.4. After researching, we found that her physician had recently made adjustments to the patient’s diuretic medication. We called the physician and reported the Zo readings. He initially held the diuretic and later adjusted the dosage and added a different diuretic to manage her weight gain. The patient has since stabilized and has not required re-hospitalization. “You couldn’t have asked for any better response from our first patient!”

CH:How did you tell your physicians about the ZOE® Monitor?

PH: Our hospital employs a physician who is a Senior Vice President for Medical Affairs and also our agency’s Medical Director. He is very well respected by our medical staff and throughout the entire system.

After talking with him about the ZOE®, he took it upon himself to search for more information. He carefully reviewed studies and other material and learned how helpful it could be managing HF patients. He shared that information with the other physicians, specifically telling cardiologists: “This ZOE® is the best thing that’s happened to home care!” He, along with our Hospital Liaison nurse, have informed the Hospitalists* about ordering a baseline Zo reading before HF patients are discharged from the hospital.

We feel that the patient’s fluid status should be at the best possible level at hospital discharge. So, taking a reading before the patient goes home provides us with a unique baseline Zo. We then can develop the home health plan of care with a baseline established for each patient’s specific parameters.

CH: What do your clinicians think about the ZOE®?

PH: We’ve talked it up for several months, but I was apprehensive on how things were going to go once we introduced it. One of our best nurses, who is somewhat frightened of technology, is the one that’s been the most thrilled. She was sitting beside me when we went through the ZOE® training. I heard her sigh a few times, and being concerned asked her, “Is everything OK?” With a gleeful look on her face, she said, “I just think this is wonderful!”

We put two ZOE® monitors on patients the first day we launched the program and we’ve had several physicians call to add the ZOE® to their patient’s plan of care. Now, the nurses plan their visits so they can take the Zo reading early in the morning for the patients who aren’t self monitoring, and they are absolutely energized by the positive patient results.

CH: How do you plan to measure patient outcomes using the ZOE®?

PH: I’m a “Data Queen” with a background in quality management. I can’t implement any telemonitoring until I can see a demonstrated benefit from it. We added the ZOE® to our HF assessment “tool kit” so we could decrease hospital readmissions and trips to the emergency room for our HF patients. Those are our two major outcome goals for the agency.

We’re on a Point of Care System (POC) so everything on the patient’s record is stored electronically. For those patients that the nurses are directly measuring the Zo, we’ve customized one of our assessment profiles to add a Zo indicator on the patient data set. We will be able to pull comprehensive reports of all patient assessments for every visit. We also have benchmarking software to identify specific patients and track their outcomes; such as if they go to the emergency room, are hospitalized, etc.

CH: What are your future plans for monitoring your heart failure patients?

PH: When a patient is discharged from home care, currently they then go to the hospital’s outpatient telephonic program. Patients are followed for six months after discharge with a weekly telephone call. These calls reinforce teaching and follow-up with anything the patient needs assistance. I’ve been working with the nurse manager for this program to add telemonitoring. When I first approached her about the ZOE®, she was skeptical and did research on her own. She’s become another advocate for us in the hospital since she sees most all the patients with HF on the inpatient side. She’s started to initiate patient referrals for the telemonitoring and the ZOE®, and talking with physicians.

For our future planning, we want to work with her on telemonitoring for the home care patients first and then tackle other patients who are not strictly homebound. We’re looking for ways to obtain the resources to keep the patient on the telemonitoring they had after discharge from home care, including the ZOE®. When we have data on our outcomes, we can show the hospital the positive patient and cost saving outcomes and tell them, “OK – we’ll also do the monitoring for all your HF patients.”

It’s a bit of a whirlwind to have this much to say about our experience with the ZOE® Monitor since we’ve only been using it for eight days! We’re all excited about the possibilities and tracking our patients’ outcomes.

*Hospitalist: A hospital-based general physician. Hospitalists assume the care of hospitalized patients in the place of the patients' primary care physician. The hospitalist model of care is not new in the U.S., but it is growing rapidly as a result of the role of managed care organizations, the increasing complexity of inpatient care, and the pressures of busy outpatient practices.