ACC Quality Summit Virtual, held Oct. 8 – 9, features 77 posters that highlight quality improvement successes at hospitals participating in NCDR, ACC Accreditation Services and ACC's quality campaigns. The top three posters that were chosen as the winners describe how they improved patient care and outcomes by reducing PCI bleeding, increasing cardiac rehabilitation (rehab), and decreasing 30-Day AMI readmissions.

First Place Poster Winner: Standard implementation of strategies aimed at reducing PCI-associated bleeding may increase patient safety, as well as staff awareness of bleeding prevention. Sara Belajonas, MSN, RN, et al., initiated a performance improvement project at Ocean Medical Center/Hackensack Meridian Health in New Jersey to reduce bleeding risk among PCI patients, using data from ACC's CathPCI Registry and tools from ACC's Reduce the Risk: PCI Bleed quality campaign. As part of the project, the cardiovascular team used ACC's CathPCI Bleeding Risk Calculator app to assess bleed risk for all patients before undergoing diagnostic cardiac catheterization. The interventional cardiologist was informed of all high bleeding risk scores before the procedures began in those patients. The team also began using radial access vs. femoral access in an effort to lower bleeding risk scores. In addition, the cardiovascular team received education to increase awareness of PCI-associated bleeding risks. The hospital's PCI-associated bleeding rate decreased from 3.15% before the program began to 1.34% after its implementation. Further, 100% of PCIs were preformed via radial access after program implementation. The researchers conclude that initiating strategies to reduce bleeding during PCIs increases patient safety and staff awareness on prevention of bleeding complications.

Second Place Poster Winner: Process improvements focused on increasing referrals for cardiac rehab and participation among patients with acute myocardial infarction (AMI) may lead to improved outcomes. Jerry Caldwell, RN, MSN, et al., focused increasing cardiac rehab referrals as a way to improve the defect-free care rate at Baylor Scott and White Medical Center-Temple in Texas, to 90%, above the compliance goal of 75% set by ACC's Chest Pain – MI Registry. An order set was added to the electronic health record that automatically populated with a cardiac rehab referral for all patients with AMI or unstable angina. A provider training program that included online notification, education about the order set, department meetings and formal communication from department leadership familiarized clinicians with the discharge order set. Finally, an inpatient cardiac rehab program was implemented to facilitate contact between the patient and exercise physiologist early in the hospital stay. At baseline, the cardiac rehab department received about 560 referrals per month, which increased to 875 per month after implementation of the order set and provider education program. The defect-free care metric increased from 79.8% in the first quarter of 2019 to 90.9% in the second quarter of 2019. In addition, the AMI performance composite increased by 90% at baseline to 99%. The researchers conclude that process improvements can lead to an increase in the referral and participation rates for outpatient cardiac rehab, resulting in a reduced risk of future cardiovascular events for AMI patients.

Third Place Poster Winner: A transition of care pathway focused on medication availability and affordability and early postdischarge follow-up visits may increase medication adherence and decrease 30-day readmissions among AMI patients. As part of ACC's Chest Pain Center Accreditation, Elizabeth A. Warren, RN, et al., sought to reduce 30-day readmissions among AMI patients at UF Health Shands Hospital in Florida by implementing a transition of care pathway focused on adherence to dual antiplatelet therapy (DAPT) and early follow up. They designed an initiative that included bedside medication delivery and enrollment in financial assistance programs to increase medication affordability. Follow-up appointments within 10 days of discharge were scheduled before patients left the hospital. Results showed that DAPT adherence increased from 56% at baseline to 92% following implementation. Patients scheduled for early follow-up appointments was 33% at baseline vs. 100% after implementation. Finally, 30-day readmissions decreased and remained low. The researchers conclude that larger studies to determine how such programs affect clinical outcomes and hospital costs are necessary. They note that similar programs could be implemented for other patient populations with high readmission rates, such as heart failure, chronic obstructive pulmonary disease and pneumonia.

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

< Back to Listings