How to Use

Introduction and How to Use the Resource Room

Congratulations on your commitment to improving the care of your patients! This Resource Room is designed to enhance the efficiency and reliability of your quality improvement efforts in order to close the gap between best practices and what we currently do in caring for the in­pa­tient with acute coronary syn­drome (ACS). This resource room is an online version of the Acute Coronary Syndrome Implementation Guide and is built on the foundation of the core principles of quality im­prove­ment, personal experiences, and evidence-based medi­cine. A re­design in process, work flow, and in­for­ma­tion is needed in order to implement effective regi­mens and protocols that optimize care for the hospitalized patient with ACS in your institution.

Essential elements for reaching breakthrough levels of improvement in the care of the ACS inpatient include:

1. Institutional support for and prioritization of this initiative, expressed as a meaningful investment in time, equipment, informatics, and personnel in the effort.
2. A multidisciplinary team or steering committee that is focused on improving the quality of care delivered to patients with ACS in your institution.
3. Data collection and reliable metrics that, at a minimum, reflect the CMS core measures and the relevant PQRI measures. These data should be transformed into reports that inform the team and frontline workers of progress and problem areas to address.
4. Specific aims, or goals, that are time defined, measurable, and achievable.
5. Standardized order sets, clinical pathways, and discharge tools that promote rational and evidence-based risk stratification, medication use, procedural use, and safe and effective transitions in care.
6. Algorithms, policies, and protocols that are institution specific and that support the order sets and promote their safest and most effective use. These tools must not merely exist; they must be widely disseminated and used and, in some cases, be embedded in the order set. A high-reliability design should be used to enhance effective implementation. These algorithms, policies, and protocols should outline and guide the caregiver’s approach to:
   1. Identifying patients with ACS;
   2. Developing a plan for care at admission;
   3. Team communication;
   4. Patient education;
   5. Medication safety and polypharmacy;
   6. Symptom management;
   7. Discharge and follow-up care; and
   8. Care measures/core measures.
7. Comprehensive education programs for health care providers and patients, re­in­forcing both general and institution-specific information, including education about the items listed under algorithms, policies, and protocols

How to Use the Resource Room

The Resource Room addresses each of these 7 elements in some detail. Although it is designed to assist leaders who are starting from scratch, the room can also benefit teams that have already made considerable progress, as it is unlikely that any institution is performing optimally in all areas. We recommend that all users initially review First Steps and Analyze Care Delivery, which will help you assess your current status on all the elements explained in these sections. Completing these sections first will put you in a position to proceed with good institutional support and to intelligently prioritize areas for intervention and allocation of resources.

Although the information is presented in an order that may facilitate the development of quality improvement efforts in many settings, you may find it difficult to follow our sequential order, as activities presented in different sections often occur in parallel in real-life settings. Your team should eventually assess and attempt to improve the full range of quality issues involving care of patients with ACS.
The room incorporates sections of all the essential elements described above to achieve breakthrough improvement. In addition, we highlight important topics and improvement tools such as run charts, process mapping, and methods to hold the gains and spread your improvement methods. Methods for demonstrating financial return on investment are also presented.

The room provides links to guidelines, key references, and examples of order sets, algorithms, protocols, and educational materials that can be invaluable to your team. We strongly encourage using these materials to build an order set or protocol that that you implement while following the general improvement framework presented in the rest of the room. This framework calls for a multidisciplinary team effort, specific goals, reliable and practical metrics, and monitoring and learning from variation from your protocol. Ignoring these principles can lead to mediocre results and disillusionment.

Following these methods can enable you to demonstrate the value of quality improvement work to your medical center and insurers, both because of the outcomes obtained and because of the cost savings often inherent in higher-quality care. With ACS in particular, the pay for reporting/performance initiatives already exists that dramatically improves your ability to demonstrate value to your institution. Demonstrating value in quality improvement and cost savings can then be leveraged for protected time for hospitalists and others to improve the quality of care and safety of the hospitalized patient.