Welcome to the second edition of the Acute Coronary Syndrome (ACS) Implementation Toolkit, which 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). ACS is one of the top reasons for admissions in our hospitals and a major source of overutilization of resources—and therefore costs— for our institutions. The Implementation Toolkit is built on the foundation of the core principles of quality improvement, personal experiences and evidence-based medicine. A redesign in process, workflow and information is needed in order to implement effective regimens and protocols that optimize care for the hospitalized patient with ACS in your institution. The second edition encompasses the addition of additional antiplatelet medications available in the market as well as accommodates recent guidelines and nomenclature in the treatment of ACS. Thorough knowledge of the treatment of ACS is considered a Core Competency of Hospital Medicine and whether your practice treats these patients during the "upstream" portion of their treatment (from symptom onset to intervention) or "downstream" (from intervention until admission), understanding the tools used to stratify our ACS patients for treatment, complications and transitions of care is essential. In contrast to the first edition of the Implementation Toolkit, we begin with a thorough review of ACS, with further sections addressing evidence-based treatment strategies and methods to assure compliance and reduce readmissions. The second part of the second edition is an update of performance improvement methodologies to be used by your group to further show your organization value.
The Implementation Toolkit is not meant to be a "one-size-fits-all" program, but only a guide. Also, in contrast to the original edition, links to multiple sources have been added to further assist the end user.
Essential elements for reaching breakthrough levels of improvement in the care of the ACS inpatient include:
I. Part One: Acute Coronary Syndrome
Although it is designed to assist leaders who are starting from scratch, the Toolkit 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 Essential First Steps and In-Depth Analysis of Current Processes and Failures, which will help to assess your current status on all of 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 Toolkit 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 Toolkit 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 you implement while following the general improvement framework presented in the rest of the Toolkit. 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 exist that dramatically improve 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.
ACS Toolkit Project Team
The first edition of this toolkit was supported in part by an educational grant from the Bristol-Myers Squibb / Sanofi Pharmaceuticals Partnership in 2008.
The second edition of this Toolkit is supported in part by an educational grant from the AstraZeneca in 2015.
The Acute Coronary Syndrome (ACS) Toolkit is an online resource for visitors to the Society of Hospital Medicine's website. All content and links have been reviewed by Acute Coronary Syndrome Toolkit Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.