The majority of Michigan Medicine patients with heart failure are eligible for this program. We encourage patients to discuss their eligibility for this program with their providers.
Inpatient Medical Care: Inpatient care is provided by Michigan Medicine hospitalists from the Michigan Hospitalists at Chelsea Service.
Inpatient and Outpatient Heart Failure Specialty Care: Inpatient care is guided by virtual consultations with a Michigan Medicine heart failure specialist. Outpatient care is provided by Michigan Medicine Heart Failure Bridges and Transitions Program. This includes both virtual and in-person visits with advanced practice providers and physicians from the Michigan Medicine Heart Failure Program as well as 24/7 telemanagement support from nursing staff trained in monitoring patient symptoms and progress after discharge.
Outpatient visits with Michigan Medicine Heart Failure specialists, pharmacists, and nutritionists are scheduled prior to discharge from Chelsea Hospital. All patients will be provided with a full list of appointments. All post-discharge visits are scheduled to last no longer than one hour. A sample post-discharge visit schedule is included below in the Patient Resources section
Nutritionists: All patients receive inpatient consultation from a Chelsea Hospital nutritionist. In addition, all patients are scheduled to see a Michigan Medicine nutritionist virtually following discharge. These visits reinforce the importance of sodium restriction and fluid restriction to avoid the fluid retention that leads to symptoms of heart failure. Patients are also provided the opportunity to take additional nutrition classes.
Pharmacists: All patients receive inpatient consultation from a Chelsea Hospital pharmacist. In addition, all patients are scheduled to have 1-2 virtual visits with a Michigan Medicine pharmacist after discharge. These inpatient and outpatient consultations focus on educating patients about heart failure medications, screening for side effects, and eliminating medications that may not be safe in heart failure.
In addition to the above team members, this program utilizes physical therapists, occupational therapists, social workers, home nurses, and others to provide the best care possible to heart failure patients.
What to Expect the First Month After Discharge
- Day 1: Nurse monitoring through Michigan Medicine Heart Failure Program begins
- Day 3: Virtual Visit with Michigan Medicine Heart Failure team
- Day 7: Virtual Visit with Michigan Medicine cardiovascular nutritionist
- Day 10: In-Person Visit with Michigan Medicine Heart Failure team
- Day 14: Virtual Visit with Michigan Medicine pharmacist
- Day 24: In-Person Visit with Michigan Medicine cardiologist or HF specialist
- Day 28: Virtual Visit with Michigan Medicine pharmacist
- Day 30: Patient assessed for need of continued nurse monitoring by HF team
