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A Quality Improvement Initiative for Increasing Cardiac Rehabilitation Referrals Using Plan-Do-Study-Act (PDSA) Methodology - 04/04/22

Doi : 10.1016/j.amjmed.2021.10.027 
Deep Sangani, MD, Vinay Krupadev, MD, Michael Crawford, MD, Brad Deere, MD, Robert Hendel, MD
 Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La 

Requests for reprints should be addressed to Robert Hendel, MD, Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112.Deming Department of MedicineSection of Cardiology, Tulane University School of Medicine1430 Tulane AvenueNew OrleansLA70112

Abstract

Background

Cardiovascular rehabilitation has been shown to improve morbidity and mortality in patients with cardiac illnesses; however, the referral rate for eligible patients at Tulane Medical Center has remained below best practice standards.

Methods

This is a single-center, quality-improvement study conducted from January 2020 through December 2020, with historical controls from 2019. Using Plan-Do-Study-Act cycle methodology, interventions were designed to improve referral rates for cardiac rehabilitation-eligible patients. Interventions included a presentation about the importance of cardiac rehabilitation and the current state of referrals, weekly reminders to residents and fellows on inpatient services with eligible patients, and an admission order set that included a default order for cardiac rehabilitation.

Results

The primary outcome was referral rate, which was measured by the total number of referrals compared with the total number of patients eligible for cardiac rehabilitation. In this quality-improvement study of 770 patients, there was a significant increase in the referral rate for cardiac rehabilitation-eligible patients. When comparing the referral rate in 2020—following institution of quality-improvement interventions—with that from 2019, there was an increase from 27% to 70%.

Conclusions

This quality-improvement study found that various interventions significantly increased the cardiac rehabilitation referral rate through a straightforward and simple strategy. Further efforts are underway to promote additional referral in order to meet or exceed the >90% best practice standard.

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Keywords : Cardiac rehabilitation, Quality improvement, Referrals


Esquema


 Funding: None.
 Conflicts of Interest: None for each author.
 Authorship: Each author had access to the data and played a role in writing of this manuscript.


© 2021  Elsevier Inc. Reservados todos los derechos.
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Vol 135 - N° 4

P. 512-516 - avril 2022 Regresar al número
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