{ "resourceType" : "PlanDefinition", "id" : "hf-admission-protocol", "meta" : { "profile" : ["http://hl7.org/fhir/StructureDefinition/cdshooksserviceplandefinition|4.0.1"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Heart Failure Admission Protocol (clinical-protocol). See Library/AtriusHFAdmission for applicability expressions and Questionnaire/hf-admission-eligibility for the ED gate.

" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-cdsHooksEndpoint", "valueUri" : "https://cds.atrius.in/cds-services/hf-admission-protocol" }], "url" : "https://atrius.in/fhir/r4/atrius-in/PlanDefinition/hf-admission-protocol", "identifier" : [{ "use" : "official", "system" : "https://atrius.in/fhir/sid/cds-service", "value" : "hf-admission-protocol" }, { "system" : "urn:ietf:rfc:3986", "value" : "urn:oid:1.3.6.1.4.1.66219.1.34.8" }], "version" : "0.1.0", "name" : "AtriusHFAdmissionProtocol", "title" : "Heart Failure Admission Protocol", "subtitle" : "ED / inpatient admission pathway for acute decompensated HF", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type", "code" : "clinical-protocol" }] }, "status" : "draft", "experimental" : true, "subjectCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/resource-types", "code" : "Patient" }] }, "date" : "2026-07-14", "publisher" : "Atrius", "contact" : [{ "name" : "Atrius", "telecom" : [{ "system" : "url", "value" : "https://atrius.in" }] }], "description" : "Person with active heart failure on the chart at encounter start: confirm ED eligibility features, then propose daily weight monitoring, sodium-restricted diet, IV furosemide, and an admission BNP when none resulted in the last 24 hours.", "useContext" : [{ "code" : { "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type", "code" : "venue" }, "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code" : "EMER", "display" : "emergency" }] } }, { "code" : { "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type", "code" : "venue" }, "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code" : "IMP", "display" : "inpatient encounter" }] } }, { "code" : { "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type", "code" : "focus" }, "valueCodeableConcept" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "84114007", "display" : "Heart failure (disorder)" }] } }, { "code" : { "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type", "code" : "venue" }, "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "code" : "ICU", "display" : "Intensive care unit" }] } }], "purpose" : "Standardize safe initial management of acute decompensated heart failure at admission, aligned with AHA/ACC/HFSA guidance, while avoiding redundant natriuretic peptide draws.", "usage" : "Invoke on encounter-start (ED or inpatient). Complete the eligibility questionnaire when the working diagnosis is acute HF, then review and place the proposed admission actions.", "copyright" : "© Atrius. Pathway structure is illustrative; institutions must adapt dosing and local formulary.", "approvalDate" : "2026-07-14", "lastReviewDate" : "2026-07-14", "effectivePeriod" : { "start" : "2026-07-14" }, "topic" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/definition-topic", "code" : "treatment" }] }, { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "84114007", "display" : "Heart failure (disorder)" }] }], "author" : [{ "name" : "Atrius Cardiology / Clinical Reasoning" }], "editor" : [{ "name" : "Atrius Clinical Reasoning" }], "relatedArtifact" : [{ "type" : "documentation", "display" : "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure", "citation" : "Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation.", "url" : "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063", "document" : { "url" : "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063" } }, { "type" : "depends-on", "display" : "HF admission ED eligibility questionnaire", "resource" : "https://atrius.in/fhir/r4/atrius-in/Questionnaire/hf-admission-eligibility|0.1.0" }, { "type" : "depends-on", "display" : "Atrius HF admission CQL library", "resource" : "https://atrius.in/fhir/r4/atrius-in/Library/AtriusHFAdmission|0.1.0" }], "library" : ["https://atrius.in/fhir/r4/atrius-in/Library/AtriusHFAdmission|0.1.0"], "goal" : [{ "id" : "euvolemia", "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/goal-category", "code" : "safety" }] }, "description" : { "text" : "Relieve congestion and maintain clinical euvolemia during the admission" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/goal-priority", "code" : "high-priority", "display" : "High Priority" }] }, "addresses" : [{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "84114007", "display" : "Heart failure (disorder)" }] }] }, { "id" : "daily-weight-trend", "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/goal-category", "code" : "nursing" }] }, "description" : { "text" : "Document reliable daily weights (same scale, before breakfast) to guide diuresis" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/goal-priority", "code" : "medium-priority", "display" : "Medium Priority" }] } }], "action" : [{ "id" : "hf-admission-root", "prefix" : "1", "title" : "Heart Failure Admission Protocol", "description" : "Active heart failure condition on the chart; run eligibility then admission management.", "priority" : "urgent", "code" : [{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "84114007", "display" : "Heart failure (disorder)" }] }], "goalId" : ["euvolemia", "daily-weight-trend"], "trigger" : [{ "type" : "named-event", "name" : "encounter-start" }], "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql", "expression" : "HF Admission Applicable" } }], "input" : [{ "type" : "Patient", "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-patient|0.1.0"] }, { "type" : "Condition", "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-encounter-diagnosis|0.1.0", "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-problems-health-concerns|0.1.0"] }, { "type" : "Observation", "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-observation|0.1.0"] }, { "type" : "Encounter", "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-encounter|0.1.0"] }, { "type" : "QuestionnaireResponse", "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-questionnaireresponse|0.1.0"] }, { "type" : "MedicationRequest", "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-medicationrequest|0.1.0"] }], "groupingBehavior" : "logical-group", "selectionBehavior" : "all", "requiredBehavior" : "must-unless-documented", "cardinalityBehavior" : "single", "action" : [{ "id" : "hf-admission-eligibility", "prefix" : "1.1", "title" : "Confirm ED eligibility", "description" : "Confirm dyspnea/congestion features and that the working diagnosis is acute decompensated heart failure before placing the admission bundle.", "priority" : "urgent", "definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/Questionnaire/hf-admission-eligibility|0.1.0" }, { "id" : "hf-admission-bundle", "prefix" : "1.2", "title" : "HF admission bundle", "description" : "Daily weights, sodium restriction, and IV diuresis for decompensated heart failure. 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