| Sumario: | Background Heart failure (HF) affects approximately 6.7 million adults in the U.S. and remains a leading cause of morbidity, mortality, and hospital readmissions (Bozkurt et al., 2023; Jiang & Barrett, 2024). Despite the proven benefits of cardiac rehabilitation (CR) in managing HF and improving quality of life, referral rates remain low (Bozkurt et al., 2021). Only 20% to 30% of eligible patients participate in this Class 1A guideline-recommended therapy (Ades et al., 2017). The lack of physician referral is a significant factor contributing to the underutilization of CR (Ghisi & Grace, 2019). Siloed healthcare systems lack effective communication and coordination, exacerbating this issue (Chindhy et al., 2020). The literature identifies multiple barriers to CR referrals, including the strategy for completing referrals (Ades et al., 2017; Fraser et al., 2022). Purpose This quality improvement project (QIP) aimed to evaluate the effectiveness of implementing an electronic referral template to improve CR referral rates for eligible HF patients compared to a previously used non-standardized paperreferral method. Methods The Model for Improvement framework was used to integrate evidence-based practice into clinical care (Ogrinc et al., 2022). The quality improvement team implemented this initiative at a 108-bed acute care facility in Northern Nevada, spanning the medical, telemetry, and intensive care units. The intervention included multidisciplinary collaboration, the creation of a CR policy, and facility-wide education. This QIP employed dissemination methods beyond traditional publications, including infographics, patient hand-outs, screensavers, facility-wide learning modules and quizzes, and organizational procedures, to ensure that healthcare professionals, patients, and their families benefit from the transformation of clinical processes (Dols et al., 2017). An audit and feedback strategy reinforced the adoption of the electronic referral template, maintained stakeholders informed and motivated, and provided an opportunity to share input. Referral rates and readmission rates were measured before and after implementation. Results Since implementation began in September 2024, CR referral rates have improved in five out of six months. A percentage change was calculated to measure the change over time compared to the starting point, with percentage increases each month--most notably a 96.6% increase in December and a 45.7% increase in February 2025. HF readmission rates decreased from 9% in 2023 to 7% as of early 2025. These findings indicate that the electronic referral template effectively streamlined the referral process and enhanced provider compliance. Conclusion Streamlining the CR referral process through an electronic referral template and establishing a standard of care through policy and procedure increased referral rates and contributed to reduced hospital readmissions among HF patients. This project demonstrates the critical role of nursing leadership and interprofessional collaboration in implementing sustainable, evidence-based interventions. It highlights the importance of policy development, stakeholder education, and patient empowerment in transforming care delivery and aligning practice with national guidelines.
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