Article Text

Download PDFPDF

A local quality initiative to improve follow-up times for patients with heart failure
  1. Toni Schofield1,
  2. Juan Duero Posada1,
  3. Farid Foroutan1,
  4. Ana Carolina Alba1,
  5. Michael McDonald1,
  6. Meredith Linghorne2
  1. 1 Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
  2. 2 Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
  1. Correspondence to Dr Toni Schofield, Department of Cardiology, Toronto General Hospital, Toronto, Ontario, M5G 2C4, Canada; toni.schofield{at}


Introduction Heart failure is the most common cause of hospital admission in patients >65 years and around 50% of patients will be readmitted within 6 months. Inability to achieve timely outpatient follow-up may contribute to the high rates of avoidable rehospitalisation for this group of patients. Canadian guidelines recommend patients with heart failure should be seen within 14 days of discharge.

Methods An audit demonstrated that less than half of advanced heart failure patients were being followed up within 14 days. In an effort to improve postdischarge follow-up in our heart function clinic, we used process mapping and applied a series of iterative changes to the appointment booking system using Plan–Do–Study–Act cycles to reduce waste and standardise.

Results The primary outcome measure, tracked over a period of 20 months, was percentage of patients booked within 14 days. At baseline, 37% of patients were seen within 14 days. After our series of interventions related to streamlining and standardising the appointment booking process, 77% of patients were seen within 14 days and 100% of patients were seen within 21 days.

Conclusion The changes made to the appointment booking process were reproducible, sustainable, effective and required no additional resources or funding.

  • continuous quality improvement
  • transitions in care
  • PDSA
  • control charts/run charts
  • process mapping

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors ML, TS and JDP: conducted the study participated in data collection, analyzed data and made iterative changes. TS, ACA and FF: analyzed the data overall and contributed to extra data collection. All authors: contributed to the editing of the paper. TS: submitted the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.