While hospital readmission rates for patients with heart failure are traditionally high, a UAMS College of Nursing graduate played a key role in establishing a nurse-led specialty clinic that has lowered that risk for its patients.
Nicole Comstock, M.N.Sc., A.P.R.N., is coordinator for the Heart Failure & Valve Clinic in the Walker Heart Institute Cardiovascular Clinic at Washington Regional Medical Center in Fayetteville. She recognized a need for more comprehensive care for heart failure patients following discharge. She also saw an opportunity where advanced nurse practitioners or advanced practice registered nurses could offer more intensive monitoring and education for patients and families.
“While a physician’s schedule is full with the most serious patients, this was a chance for the expertise of a nurse practitioner
to be able to make a real difference for newly discharged heart failure patients,” said Comstock, who graduated from the MNSc program at UAMS in 2010. “These patients have a very strict diet and need to be vigilant for symptoms that could lead to readmission, so our team is able to have more education prior to discharge and regular follow ups by phone and in person.”
She pitched the idea to Joel Carver, M.D., a cardiologist in the Walker Heart Institute Cardiovascular Clinic where she had been working. He encouraged her to research further, meet with hospital administrators and develop a proposal — a plan that came to fruition when the heart failure clinic opened in 2011.
“The clinic has helped our patients focus on their health through the education and support that Nicole and her team provide for maintaining a better quality of life as the patient transitions from the hospital to home,” Carver said. “She spent a lot of time researching best practices and visiting other facilities to build a program that has decreased hospital readmissions for our heart failure patients.”
Carver, himself a 1978 graduate of the UAMS College of Medicine, credited Comstock with the initiative and hard work of developing then implementing the processes and patient protocols that has made the clinic successful.
“Nicole’s work shows how you can truly make a difference in the lives of patients and I think that’s why we’re all driven to be nurses,” said Janet Rooker, M.N.Sc., R.N.P., clinical associate professor in the College of Nursing.
Comstock visited with Rooker about the possibility of the clinic while she was still a student. Rooker also encouraged her to follow up on the vision.
“She was very compassionate and positive but very determined to make this happen as it was all about improved patient outcomes,” Rooker said, adding that patient education — and ensuring patients understand the sometimes complex instructions they are given — is a role where nurse practitioners can have an impact “and Nicole is a prime example.”
On a daily basis now, Comstock is identifying hospital patients diagnosed with heart failure. She consults an interdisciplinary team that includes pharmacists, physicians, case managers, dieticians, administrators, inpatient educators, respiratory therapists and charge nurses. In this way, she and her team, which includes a registered nurse and clinic staff, are already planning for a patient’s discharge and follow up.
“We introduce ourselves to the patient and their family prior to discharge whenever possible and the patient receives our direct contact information in case the need arises after discharge but prior to their first clinic appointment,” Comstock said.
After discharge, patients are scheduled for phone calls with clinic staff within 24-48 hours and then at least weekly for the next six weeks. These calls prompt patients to check their vitals and other measurements and identify any potential issues.
The clinic is the only one in northwest Arkansas focuses solely on heart failure patients, she said. Their success has led to an increase in referrals from across the region.
Looking ahead, Comstock said she would like to work and develop satellite clinics to better reach patients in rural areas.
She credited the College of Nursing for preparing her and nurturing her ideas for the clinic, even while she was still in school.
“When I graduated, I felt I had been given the skills I needed, plus the support and encouragement — they really pushed me to do this,” she said. “Getting a graduate degree opened so many doors.”
Comstock called herself fortunate to have a job where she wakes up and looks forward to going to work every day. “I love it.”
Another aspect of the work she enjoys — working with her sister Brandi Barnes, M.N.Sc., A.P.R.N., a 2011 graduate of the College of Nursing master’s program, who works in the Walker Institute Cardiovascular Clinic.
“We encouraged each other during school,” Barnes said. “And we’re best friends.”
The sisters said a desire to work in health care and to help people led them to nursing. Plus, a grandmother was a longtime nurse in a family medicine clinic in Fayetteville.
After earning her bachelor’s degree, Comstock worked as a nurse in the intensive care unit for six years.
“I loved it and I loved working in the hospital, but the opportunity to potentially do something more was interesting to me,” she said of pursuing a graduate degree.