Nurse Practitioner Heads a New Heart Failure Clinic

When Cleveland Clinic’s Medina Hospital opened its Heart Failure Clinic in the fall of 2013, the community hospital turned to a nurse practitioner to lead the endeavor. June Hart Romeo, PhD, MSN, CNP, acts as clinic coordinator. It’s a perfect role for the nursing veteran, who helped to develop a BSN program as a former education division chair at Baldwin Wallace University in Berea, Ohio.

The Heart Failure Clinic works in conjunction with referring physicians to manage patients with heart failure, optimize their health status and decrease hospital readmissions. It is part of the Cleveland Clinic healthcare system’s overall commitment to remaining No. 1 in heart care, a designation bestowed by U.S. News & World Report for 20 years. The goals of the year-old clinic are as follows:

• Collaborate with physicians in the complex and labor-intensive management of heart failure
• Maximize efficiency and cost-effectiveness
• Decrease hospital readmissions
• Maximize quality of life for patients with heart failure
• Educate patients

While medical oversight is provided by Medina Hospital’s Director of Cardiovascular Services, Romeo is the healthcare provider at the clinic and her duties are varied: She serves as a clinician, care coordinator, sounding board and more.

“Patients can contact me with things that might seem insignificant, but are actually major issues,” says Romeo. “They may be reluctant to call their physician when they are a little short of breath or have gained a pound. I am an additional resource for them.”

When new patients visit the Heart Failure Clinic, Romeo takes a complete medical history and does a physical examination. She reviews medications and prescribes new ones as indicated by the American College of Cardiology’s guidelines. These may include beta-blockers, ACE inhibitors and diuretics. Romeo also orders baseline laboratory work and educates patients on living with heart failure. During follow-up appointments, the nurse practitioner reviews the patient history, performs a physical exam, evaluates therapies, orders necessary lab work and continues educating the patient.

“This population really needs nursing, so it’s a perfect role for a nurse practitioner,” says Romeo. “I have the ability to manage the full scope of my patients’ healthcare problems.” She collaborates with cardiologists to ensure patients are getting the proper care, sending appointment summaries to physicians through the electronic medical record system. Romeo tries to schedule her appointments with patients a week or so before they see their cardiologists, so she can help them write down any questions they may have for the physician.

Romeo also monitors other conditions, such as diabetes and hypertension, and gets patients appointments with specialists when necessary. “I’m not only a healthcare provider, I’m a healthcare coordinator,” says Romeo. “I try to make sure patients don’t get lost in the cracks in the system.”

To that end, patients have Romeo’s direct phone line. She calls them back – or schedules appointments – the same day. Patients are reassured that they can talk to her about unusual weight gains, shortness of breath, edema, wheezing or other issues.

“Heart failure is a labor-intensive syndrome,” says Romeo. “Patients are often overwhelmed because they are tired and not feeling well, depending on their ejection fraction and how far advanced they are. It’s comforting to them to know they can call me.”

Hopefully such close contact with patients also will decrease hospital readmission. When patients with heart failure are discharged from Medina Hospital, a registered nurse who serves as a patient care advocate ensures they have a follow-up appointment within one week – either with their cardiologist or the Heart Failure Clinic. “Research shows that if they are seen within seven days of discharge, they are less likely to be readmitted within 30 days,” says Romeo.

It’s too early to make a definitive connection between patient visits to the clinic and hospital readmission rates. However, Romeo notes that only three of the 175 patients she has cared for have been readmitted to Medina Hospital within 30 days of discharge with issues related to heart failure. In addition, the overall heart failure readmission rate is approximately 14 percent, well below the national average.

“The Heart Failure Clinic is great for patients and a wonderful opportunity for me as a nurse practitioner,” concludes Romeo.