Improving Cardiac Care by Regular Reviews of Core Measures

Intervention Title:
Improving Cardiac Care by Regular Reviews of Core Measures

Hospital:
Washington Hospital Center; Washington, D.C.

Goal:
Improve the quality of cardiac care delivered to patients.

Innovation:
Cardiology nurse practitioners, both employed by the hospital and private, meet regularly to conduct practice reviews. To improve the quality of care delivered to the patients they serve, it was decided to incorporate a review of core measures in regular meetings.

Result:
The group’s decision resulted in a more collaborative relationship in which all nurse practitioners were able to become familiar with and improve adherence with quality performance measures. As a result, the hospital saw an increase in adherence of near 90 percent for core measures, ranging from giving aspirin at discharge, to the ordering of ACE-I/ARB for heart failure patients.

Institution:
Washington Hospital Center
110 Irving St. NW
Washington, D.C. 20010
P: (202) 877-7000

From the C-Suite:
“To have all nurses dedicate part of their scheduled meeting to discuss areas where improvement is needed and ideas for how to get there is a simple vehicle for developing new ideas for improving patient care and a way in which to quickly increase the quality of care delivered.”


Elizabeth Wykpisz
Chief Nursing Officer


Profile:
Washington Hospital Center is the largest private hospital in the nation's capital with 926 licensed beds offering primary, secondary and tertiary health care services to adult and neonatal patients.

Clinical areas affected:

  • All clinical units in the Heart and Vascular Institute

Staff involved:

  • Nurse practitioners
  • Nursing managers
  • Registered nurses

Timeline:
The group began discussing core measures in 2007.

Contact:
Karen Mack
Chief Cardiology Nurse Practitioner
karen.mack@medstar.net
P: (202) 877-7000

Innovation Implementation:
Washington Hospital Center's program in cardiovascular services is among the top 20 centers in the U.S. Washington Hospital Center aims to be a leader in providing safe, effective and efficient care to patients in the Washington Metropolitan Area that is backed by sound medical research.

The hospital, like many institutions, has two groups of nurses treating patients at the hospital –those employed directly by the hospital and those employed by private medical groups. These two groups in the cardiac care unit meet regularly to facilitate practice reviews. In 2007, Washington Hospital Center was undergoing a major push to improve quality and the Chief Cardiology Nurse Practitioner (CCNP) was tasked with developing a few ways nurses in the cardiac care unit could improve the quality of care they deliver. The CCNP decided a simple way to improve the quality of patient care was to ensure that all nurses treating cardiac patients were aware of all the evidence-based standards of care guidelines. For patients suffering from heart failure, it is critical that they are provided with all of the evidence-based care they need.

One channel the CCNP uses to communicate with all nurses in the unit is the nurse practitioner combined cardiology practice committee. The group meets regularly to conduct practice reviews. As leader of the group, the CCNP decided to add an item to the meeting agenda to discuss specific core measures relating to patients suffering from heart attacks or heart failures. Nurses welcomed the idea to polish their knowledge of core measures and enhance the care they provided.

Advice and lessons learned:

  1. Provide the opportunity to gather other ideas. Having all the nurse practitioners meet together is a good time to gather their ideas about other projects that would improve patient care. The Washington Hospital Center’s nurse practitioner combined cardiology practice committee also developed a new discharge tool for the hospital.
  2. Get everyone involved. Try to have everyone in the group participate by asking them questions or having each person lead a meeting.

Cost/benefit estimate:
There was no cost to reviewing core measures at the meeting. The Washington Hospital Center saw an across the board 90 percent adherence for core measures for heart failure patients, like HF-3 and AMI-2.