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Resident-initiated interventions to improve inpatient heart-failure management. BMJ Qual Saf 2011 Feb;20(2):181-6

Date

02/10/2011

Pubmed ID

21303773

Pubmed Central ID

PMC4518550

DOI

10.1136/bmjqs.2009.039339

Scopus ID

2-s2.0-79953789700   6 Citations

Abstract

BACKGROUND: Third-year internal medicine residents participating in a quality improvement rotation identified gaps between the Joint Commission's ORYX quality guidelines and clinical practices for the inpatient management of heart failure (HF) at the William S. Middleton Memorial Veterans Hospital. Residents focused on the performance metrics associated with tobacco-cessation counselling documentation, ejection fraction assessment and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescriptions.

METHODS: After analysing data collected by the External Peer Review Program, residents reviewed the institution's admissions and discharge processes with the aim of improving quality and compliance. In redesigning these processes, residents created an admissions template and a discharge face sheet, and compared specific ORYX measure compliance rates before and after institution-wide implementation.

RESULTS: Following implementation of the tobacco-cessation admissions template, 100% of HF patients who used tobacco received documented cessation counselling, compared with 59% prior to intervention (p<0.01, n=32). Following implementation of the mandatory discharge face sheet, 97% of HF patients (compared with 92% preintervention, p>0.05) received comprehensive discharge instruction; LV function assessment went from 98% to 100% (p>0.05); and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription for left ventricular systolic dysfunction at discharge (or documentation of a contra-indication) went from 82% to 100% (p<0.01, n=48).

DISCUSSION: By implementing a standardised admissions template and a mandatory discharge face sheet, the hospital improved its processes of documentation and increased adherence to quality-performance measures. By strengthening residents' learning and commitment to quality improvement, the hospital created a foundation for future changes in the systems that affect patient care.

Author List

Oujiri J, Hakeem A, Pack Q, Holland R, Meyers D, Hildebrand C, Bridges A, Roach MA, Vogelman B

Author

James Oujiri MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Counseling
Disease Management
Heart Failure
Humans
Inpatients
Internship and Residency
Joint Commission on Accreditation of Healthcare Organizations
Medical Audit
Organizational Case Studies
Physician's Role
Quality Assurance, Health Care
Smoking Cessation
United States
Wisconsin