What's critical to improving care for acute myocardial infarction (AMI) patients? Communication, team-based care and education for providers were the common themes for two hospitals – Indian River Medical Center (IRMC) and Central Lynchburg General Hospital (CLGH) – that experienced improved outcomes through participation in ACC's Chest Pain – MI Registry, Accreditation Services' Chest Pain Center Accreditation and the original Patient Navigator Program.

Beginning in 2014, data from the Chest Pain – MI Registry showed a decrease in the overall defect free care measure for AMI patients at IRMC in Vero Beach, FL. The overall defect free care measure reviews the proportion of patients receiving "perfect care" based on ACC/AHA guidelines.

A multidisciplinary team was tasked with developing strategies to improve outcomes. The team's efforts helped the hospital reach an overall defect free care score of 91.4 percent in the first quarter of 2016, well above the national 50th percentile benchmark of 78 percent for Chest Pain – MI Registry hospitals. How did the team achieve such dramatic results? They analyzed Chest Pain – MI Registry data and improved care processes as part of the Chest Pain Center Accreditation. The hospital also joined the inaugural Patient Navigator Program, which helped identify care gaps and reduce AMI readmissions.

"More than anything, the registry and accreditation helped us analyze data and put in place processes to provide improvement," says Diane Loveday, RN, IRMC patient care navigator. "The registry is a good place for data collection, but the point is you have to do something with the data. It's not good enough to just abstract data."

The multidisciplinary team turned to IRMC's electronic health record (EHR) to identify improvement areas, adding order sets for discharge medications and cardiac rehab. After its success with the original Patient Navigator Program, IRMC continued with ACC's Patient Navigator Program: Focus MI, becoming a Diplomat Hospital and quality leader for other hospitals. "When you have a process in place where everyone has input, things definitely get better," Loveday says.

CLGH in Lynchburg, VA, was already participating in the Chest Pain – MI Registry and had earned the Chest Pain Center Accreditation, but was determined to further reduce AMI readmissions. As part of its participation in the Patient Navigator Program, the hospital hired nurse-navigators to work directly with AMI patients, helping them prepare for discharge. The nurse-navigators scheduled patients for follow-up appointments with cardiologists within seven days of discharge. For patients who couldn't see a cardiologist in that timeframe, the newly established Hospital to Office (H2O) clinic provided a place for patients to discuss medications and lifestyle changes with a nurse. The 30-day AMI readmissions rate decreased from 28.3 percent to 15.5 percent in 2016, with additional decreases in 2017.

The nurse-navigators, were "crucial" to the process, says Cindi Cole, BSN, RN, CCCC, director of critical care quality programs at CLGH. "They establish the relationship with the patient, so they know the person who will follow up with them after they're discharged."

Clinical Topics: Cardiovascular Care Team

Keywords: Patient Readmission, Patient Navigation, Benchmarking, Chest Pain, Chest Pain MI Registry, Patient Discharge, Accreditation, Registries, Myocardial Infarction, Electronic Health Records, Patient Care Team, National Cardiovascular Data Registries, Quality Summit

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