During ACC Quality Summit Virtual, Oct. 8 – 9, three posters, representing NCDR, ACC Accreditation Services and ACC's quality campaigns, received Honorable Mentions. The posters focused on reducing hospital stays following ICD implantation and on increasing referrals to outpatient cardiac rehabilitation (rehab) using tools available through NCDR, ACC Accreditation Services and ACC's quality campaigns.

NCDR: A hospital stay of one to two days following ICD implantation or generator change may be feasible, safe and cost-effective. Khalid Almuti, MD, FACC, et al., used data from ACC's ICD Registry to look at efficiency and patient safety associated with shorter hospital stays among 156 patients who received an ICD at Cleveland Clinic Abu Dhabi between July 2015 and June 2020. Results showed that 123 patients received an initial ICD implant, while 33 patients had an ICD generator changed. Among the patients receiving an initial ICD, 96 (78%) had a hospital stay of less than 48 hours, with an average stay of three days. Among patients receiving an ICD generator change, 25 (76%) were discharged the day of the procedure, with an average stay of two days. There were no mortality cases or major adverse events in either the initial ICD implant or ICD generator change groups. The researchers conclude that limiting the hospital stay to one to two days following an ICD-procedure is feasible, safe and cost-effective in the Middle Eastern population. They note that preprocedure phone calls with the patient to discuss preprocedure instructions helps prepare patients for the procedure. In addition, they add that postdischarge phone calls help providers evaluate patients to ensure there are no complications and to reinforce postprocedure instructions.

ACC Accreditation Services: A multidisciplinary, team-based approach may help increase referrals to cardiac rehabilitation among myocardial infarction (MI) and PCI patients. Charyl T. Asuncion, MSN, et al., initiated a team-based approach to improve the process to ensure MI and PCI patients received cardiac rehab referrals before discharge. The project aimed to increase compliance with cardiac rehab performance measures for ACC's Chest Pain – MI Registry and CathPCI Registry. As part of process improvement for ACC's Chest Pain Center Accreditation and Cardiac Cath Lab Accreditation, an order set that included a preset referral for cardiac rehab for all MI and PCI patients was added to the hospital's electronic health record system. PCI patients also automatically received cardiac rehab educational materials in their visit summary. All members of the cardiovascular team received education on using the automated order set, educational materials and identifying patients who should receive cardiac rehab referrals. In addition, postdischarge follow-up phone calls from the MI nurse navigator and cardiac rehab nurse confirmed patients were enrolled in an outpatient cardiac rehab program. Results showed that the compliance rate for the cardiac rehab performance measure increased from 91.3% to 100% for the Chest Pain – MI Registry and from 71.2% to 100% for the CathPCI Registry. The researchers conclude that the multidisciplinary, team-based approach to increase cardiac rehab referral led to better compliance, decreased staff burnout and a smaller risk of process failure.

ACC Quality Campaigns: A nurse navigator dedicated to MI patients may help increase patient engagement and reduce readmission rates. As part of the Patient Navigator Program: Focus MI, Eleanor A. Rawls, MSN, hired an MI nurse navigator at WakeMed Health & Hospitals in North Carolina, with the goal of maintaining the hospital's readmission rate below 6% and increasing postdischarge engagement with MI patients by 50%. The dedicated MI navigator worked with the MI program manager to learn about the daily patient review process and readmission risk assessment and met with the heart failure (HF) navigator to review the outreach process. In addition, the MI navigator shadowed the cardiac rehab program to improve patient education skills, build patient relationships and learn how to provide accurate information to patients regarding cardiac rehab. The cardiovascular team – including cardiologists, cardiothoracic surgeons, hospitalist physicians, advanced practice providers and clinical nursing staff – was encouraged to enlist the new navigator as a resource. Results showed that at baseline, in the first quarter of 2018, 14% of patients were reached within 30 days, compared with 62% in the second quarter of 2019 and 69% in the first quarter of 2020. The 30-day readmission rate was 6.15% at baseline vs. 4.88% in the second quarter of 2019 and 4.29% in the first quarter of 2020. The authors conclude that a dedicated nurse navigator can impact patient engagement and contribute to reduced readmissions. Rawls notes that patients now receive a call within two or three days of discharge and that efforts are underway to standardize workflow between the MI and HF navigators.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention

Keywords: Quality Summit, Patient Readmission, Cardiac Rehabilitation, Length of Stay, Platelet Aggregation Inhibitors, Patient Discharge, Hospital Costs, Medication Adherence, Electronic Health Records, Patient Safety, Outpatients, Inpatients, Quality Improvement, Percutaneous Coronary Intervention

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