Heart Failure
Pathway Objectives
To monitor patients with Congestive Heart Failure (CHF) and offer resources that support heart health i.e. smoking cessation program enrollment
Timeline: Daily questionnaire and assessment of vital signs and weight. Ongoing (for 51 weeks).
Circle of Care – Patient & Care Coordinator & Care Team
Physician, Nurse, Pharmacist, Dietician
Assigns patient to a care coordinator (CC) who monitors patient status including vital signs, O2 stats, blood work (i.e. hemoglobin, K+, Na+), weight, level of anxiety, and symptoms related to Congestive Heart Failure (CHF)
Full labs, history, and medication is made available to the care team
All subsequent visits are scheduled with patient and reminders are added for appointments and required questionnaires (i.e. QOL, 6 min walk test, health behavioral goals, patient satisfaction with care)
CC task reminders are also scheduled prior to each visit to ensure a thorough follow up and assessment (i.e. medication review, review of clinical history, QOL and 6 min walk test)
Daily vitals monitoring, weight, and questionnaires related to breathing, sleep, and overall condition (symptoms) are assessed
Care team is notified of values that are out of range; clinical interventions include a patient notification to contact clinic or MD (patient can contact care team directly via platform), or to go to ER
Smoking cessation program (if the patient is a smoker) is offered every 2 weeks and care team is notified of patient’s request for enrollment
Care Pathways
Improving the wellbeing of your patients is our number one priority. That is why we offer a wide range of care pathways, to meet individualized health needs.
What our customers say about us
Using the aTouchAway™ COPD Care Pathway, we have been able to support our patients at home with required respiratory and oxygen therapy, managing them safely and avoiding unnecessary hospital or clinic visits. aTouchAway™ proves to be effective in augmenting patient care while expanding team capacity and saving travel time for our organization.
Miriam Turnbull
VP & GM at ProResp
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