Cardiology Admission Orders Physician's Order Sheet

Intervention Title:
Comprehensive Cardiology Admission Order Set to Improve Provider Compliance With Core Measures – Mount Sinai Hospital Medical Center;Chicago, Ill.

Improve provider compliance with providing evidence-based care to cardiac patients upon hospital admission.

Staff replaced three separate order sets for ST elevation Myocardial Infarction (STEMI), acute coronary syndrome (ACS) and heart failure (HF) patients with a single, standard cardiology admission order set.

The single order set has reduced provider confusion and helped the hospital reach regular compliance rates of 90 to 100 percent for evidence-based cardiac measures.

Mount Sinai Hospital Medical Center
California Avenue at 15th Street
Chicago, IL 60608
P: (773) 542-2000

From the leadership:
“The comprehensive order set has been a powerful tool in our efforts to meet documentation requirements for core heart measures. Physicians now have access to a single, simple form that includes all of the required information, instead of our previous three-form system that caused a lot of confusion. As with all paperwork, this just goes to show that simpler is always better.”

Christopher Cornue, M.S.H.S.A., F.A.C.H.E.
Vice President, Physician Services

Mount Sinai Hospital Medical Center is a 431-bed teaching hospital.

Clinical areas affected:

  • Cardiology

Staff involved:

  • Emergency Department director
  • Chief of medicine
  • Cardiology Department
  • Nurse educator
  • Forms committee
  • Administration

Development of the comprehensive order set took three to six months, primarily because of the consensus building efforts that were necessary.

Anh Nguyen, N.P.
Lead Cardiology Nurse Practitioner
P: (773) 257-6452

Innovation implementation:
The wide variety of admission types and care measures that health care providers have to deal with has led many hospitals to develop individual admission order sets that address each situation independently. The problem with this approach is that providers oftentimes find it cumbersome to locate and choose the appropriate form, leading to an avoidance of specialized forms in favor of ‘blank' ones and, therefore, a possible reduction in compliance with core heart measures.

At Mount Sinai Hospital the situation was addressed by combining the critical information from the three existing order sets—for HF, ACS and acute myocardial infarction (AMI)—into a single, comprehensive cardiac set. The final set, which ensures that all core measures and treatment options are accounted for, was developed and refined with close input from all staff that would ever use it. After this process, the set was sent to the hospital forms committee for formal approval before widespread adoption. It is updated on an as-needed basis to reflect changes in the hospital and measures.

Additionally, Mount Sinai standardized the location of the comprehensive order set across nursing units and placed it in the hospital's electronic forms system. This change improved its availability and ease of use for physicians.

Advice and lessons learned:

  1. Have a champion for the effort. The effort to develop a single resource like the comprehensive order set requires a lot of consensus building and legwork. It is important to have a single champion lead the effort and push it through the necessary barriers.
  2. Bring everyone involved to the table. Make sure to let everyone who will be affected by the new order set have a voice in its development. Doing so will reduce opposition and make gaining acceptance easier.
  3. Choose a strategy and stick with it. After you decide on a strategy for the order set, stick with it despite any difficulty or opposition you might face. Deviating from your original strategy will only set the process back.

Cost/benefit estimate:
There were no new costs associated with development of the comprehensive cardiology order set besides the use of existing employee time. By ensuring documentation and compliance with the core heart measures, performance scores improved, which is worth the employee time and effort invested.