First Steps

Garnering institutional support, assembling a team, team rules, and understanding the framework for improvement

Introduction: Recognizing and Defining the General Quality Problem
Quality improvement projects should always develop from recognition of a gap between the level of care that is optimal and best supported by the evidence contrasted with the care that is actually being delivered to your patients.

Optimal Care for the Inpatient Hospitalized for Acute Coronary Syndrome
Team leaders need to be thoroughly familiar with the principles of the management of acute coronary syndrome in hospitals but do not need to be cardiologists. Reviewing the appropriate sections in this Resource Room, including important reviews, position papers, and guidelines, and reviewing the annotated bibliography of key literature in the Best Practices section should bring you up to date quickly if you are not already well versed in this literature. (Analyze Care Delivery highlights other factors that make up optimal care, but this more-detailed examination can wait for now.)

Looking into the Gap
Analyze Care Delivery lets you to delve into the details of the care you currently provide and to recognize opportunities for improvement, while the metrics needed to accurately and reliably measure the quality of care your patients enjoy is fully outlined in Track Performance.  A multidisciplinary approach and institutional support are needed to really complete these sections. Because of the emphasis placed on ACS quality in the CMS Hospital Compare project, obtaining institutional support for efforts at improving the quality of care for patients with this disease should be straightforward. If this is not the case, however, how are you to convince colleagues and the administration that the care currently being delivered is suboptimal and to galvanize full participation in your cause? A quick review of a small selection of patients with ACS can provide you with some numbers to convey the reality, size, and scope of the problem to others and help you to enlist members to join a multidisciplinary team to address the care of patients with ACS in your medical center.

View What’s the Problem? Ideas for Early Data Collection which offers some ideas about how to collect early data that is suitable for this task in both the critical care and non–critical care areas, often with very small samples of patients. Methodological rigor is not as important at this stage, as you are only trying to gather enough information to form a committed multidisciplinary team and gain enough institutional support to get started.

A Draft Memo to Administration or Executive should provide you with more evidence for making ACS care a priority with your medical center administration and clinical leadership, along with  Building the Business Case for Your ACS Improvement Efforts, which addresses financial aspects.