News & Events

Congestive Heart Failure Clinic is making a difference in patients’ health; wins quality excellence award

Date: 01/23/2020

On hand at the presentation of the Quality Performance Excellence Award to Northern Light AR Gould Hospital for its CHF Clinic were, from left:  Tim Dentry, senior vice president and chief operating officer of Northern Light Health; Dr. Jay Reynolds, vice president and senior physician executive at Northern Light AR Gould Hospital; Kim White, RN, nurse navigator for the CHF clinic at the hospital; John Raymond, PA-C, a cardiology provider and driving force behind the CHF clinic; and Dr. Steven Berkowitz, the former senior vice president and chief physician executive for Northern Light


Presque Isle, Maine (January 23, 2020) — To better serve patients, Northern Light AR Gould Hospital created a unique clinic for congestive heart failure (CHF) patients last year. The program has had made a major difference in the quality of life for participants, and its incredible success was recently recognized when the program was named the first-place winner of the Quality Performance Excellence Award presented at Northern Light Health’s second annual Quality Summit.


Congestive heart failure is when the heart can’t pump blood normally. It can make a person feel weak, tired, or dizzy.  It can also affect your lungs and make you short of breath. CHF patients can struggle with activities in daily life as well as health issues related to their CHF. 


“Heart failure is the number one cause of readmission here and throughout the country,” says John Raymond, PA-C, a provider in the hospital’s cardiology department.  “These patients can be very sick, with multiple medical issues. We wanted to do something for these patients in Aroostook County.”


According to Raymond, the national average of hospital readmission for CHF is about 23 percent, while AR Gould’s rate had hit as high as 33% at some points. To change this situation, a series of meetings were held with staff and providers from all of the departments involved in CHF care. The group included cardiologists, nurses, primary care providers, dietitians, pharmacists, hospitals, and cardiac rehab staff.


“By all talking it out with each other, we found areas we could improve upon, but the biggest issue was communication. We were all doing great in our own departments, but we needed to improve communication between these departments and between inpatient and outpatient care,” explains Raymond. “When a patient leaves, we need to make sure they are educated and follow through on that education.”


The CHF Clinic they developed pulls together all of these resources within the hospital to better guide patients living with CHF.  The clinic follows guidelines from the American College of Cardiology and the American Heart Association. It includes an organized, interdisciplinary team, a standard education program, and a fine-tuned communication system. Patients are followed after discharge, and the program continues to evolve to meet their needs.


A key component is a patient nurse navigator who ensures patients are getting the education they need and that proper follow-up is done. She serves as the link between the patients and their families with providers, home care nurses, inpatient nurses, and others associated with their CHF care. She makes regular calls to check in with patients, checking on their symptoms and answering questions. Raymond equates Kim White, RN, the CHF nurse navigator, to the “quarterback” of the program.


The program has grown over the past year to include roughly 200 patients across The County who the team of Northern Light Heart & Lung are following closely.  And statistics prove the clinic has made a difference.  Readmission rates for CHF patients are now averaging only eight to ten percent at the hospital.


With this success in mind, the program was nominated for a quality award in competition with programs from across the Northern Light Health system, which includes nine hospitals, a statewide home care and hospice system, continuing care facilities, primary and specialty care practices, and ground and air medical transport services. 


Northern Light AR Gould Hospital’s CHF Clinic was one of three finalists for the Quality Performance Excellence Award. After a presentation by the finalists at the Annual Quality Summit, the CHF Clinic was selected as the first-place winner.


“While this recognition is appreciated and the statistics are exciting, what really makes a difference for us personally as providers are the stories of the quality of life improvements we hear from our patients,” says Raymond.  “That’s what really matters. We are proud to have made a difference.”


Leaders from the hospital and the Heart and Lung practice are now planning to use this model to create a COPD clinic for pulmonary patients in Aroostook County.