How did we do it?

The design and implementation process followed the Plan-Do-Check-Act (PDCA) model for quality improvement. Implementation began in October 2004. Major project activities included:

1. The project charter was approved by leadership and Quality Council in October 2004.
2. Physicians caring for patients with the diagnosis of chest pain/ rule out heart attack, severe heart problems, acute heart attack, heart failure, and any other similar diagnoses, were interviewed. Discussion included:

A. Best practice evidence based medicine
B. Individual beliefs regarding care of patients with identified diagnoses
C. Barriers to providing the best care
D. Methods to achieve best practice measures

3. Nursing staff were interviewed both at staff meetings and individually. Best practice was discussed and information was exchanged regarding evidence based protocols for treating patients with acute heart attacks and severe heart problems.

4. Order sets were created based on the discussion.

5. A care plan was developed that can be individualized for these types of patients.

6. Education and training was provided to both physicians and nursing staff regarding delivering evidence based medicine.

7. Ongoing data collection and reporting

8. Laminated Best Practice Guidelines were placed next to each dictation phone and pocket cards were provided to the physicians.

9. Daily meetings were held with physicians and nurses for the first six months to offer support and education.

10. Data was compiled using a risk stratification tool, which included encounters with all physician areas (emergency department (ED), internal medicine, nephrologists, family practice, cardiology); then we provided feedback to individual physicians with respect to how he/she was doing in providing desired measures for his/her patients.

11. Physicians and nursing staff that provided evidence based best practice care were recognized personally and publicly.

12. Compliance to Core Measures Data through JCAHO was regularly monitored and shared with the medical staff.

13. A privileging and credentialing packet was created in collaboration with the Medical Staff Department to educate and inform physicians about facility expectations regarding documentation and treatment of patients that fall into this category.

14. Enlisted help from physician champions from Cardiology, ED, Hospitalists, Internal Medicine, Nephrology, as well as from Quality Council, Critical Care and Cardiology Committee, and the Department of Medicine and posted results via poster boards.

15. Holding the gains -- using positive reinforcement to encourage ongoing excellence.