Congestive Heart Failure

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A patient with Congestive Heart Failure and Cardiac Asthma is being monitored by a certified homecare agency following a recent hospital discharge. The patient lives in an underserved area, and there is a critical shortage of Cardiac trained nurses within this agency’s particular branch. Field visits must therefore be scheduled strategically, and be limited to an exception-based schedule (as opposed to a fixed schedule). Using a combination of televideo with stethoscope as well as a telehealth scale, blood pressure monitor and thermometer, the agency typically substitutes one in three in-person visits with a “virtual visit.” During one such virtual visit, the nurse care manager does a complete workup on the patient, checking all vitals, observing pill bottle labels, requesting repeat demonstrations of blood pressure techniques, checking for swelling, etc. – everything short of physically laying hands on the patient. The nurse then requests that the patient place the stethoscope diaphragm in various places, while watching on the video, and assists the patient in making adjustments when misplaced during assessment of heart and lung sounds. At one point, the nurse detects a possible dysrhythmia, and records the session for consultation with the patients’ physician later. The visit ends with the nurse providing some education on medication and diet adherence.

After forwarding the suspected heart sounds to the physician, the nurse is told that the patient is likely stable, but an appointment to the doctor’s office is scheduled. Together, the doctor and nurse determine that the next scheduled nurse visit could once again be via televideo, but that could change if vital signs or self-reported symptomatology in the coming week warrant an in-person visit.