Structure Metrics

By Chad Whelan, MD & David Klocke, MD

Not all quality improvement programs in the area of ACS will have structure outcomes. However, these are worth considering depending on the nature of your intervention. A structure metric is used to determine if you have the right infrastructure to effectively implement and update your intervention. The logic behind this is that in order to change outcomes (the ultimate goal) you must first have a structure that can support the implementation of processes that are felt to lead to better outcomes. This is the most basic (but not simplest) step in your quality improvement project. Examples in the area of ACS might include:

1. A multidisciplinary cardiac catheterization initiation team that does not require a cardiologist to start the process.
2. Communication tools that allow better hand-off of information around ACS care as a patient moves through the system.
3. Order sets for patients with ACS that are tailored to their risk based on formal risk stratification tools.(Visit the Clinical Tools section for examples of order sets and care maps).
4. Embedded clinical decision support systems for institutions that have EMRs in the area of ACS.
5. A method in place to review and update the tools you have decided to use, be they hand-off tools, paper order sets, or embedded electronic decision support.