Design of a Cardiovascular Discharge Tool: An Optimization Project

Background: National public reporting by hospitals and healthcare systems provides transparency and accountability to the public regarding cardiovascular surgical outcomes. The Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC) have data registries in which hospitals can participate in this reporting. These registries generate performance scores for participating institutions. Intermountain Health's Cardiovascular program has fallen short of meeting its goals for exceeding "better than expected" ratings, or 100% achievement. Methods: This optimization project looked at four Intermountain Health System hospitals in Utah that report outcomes to the STS and ACC after a cardiovascular (CV) intervention. Using Intermountain Health's systems development lifecycle (SDLC) as a guide, the project's primary focus was evaluating the discharge workflow and recommended discharge medications. The evaluation was done by identifying patient encounters where recommended medication prescribing was missed, looking at current discharge order sets, meeting with CV providers who excelled at meeting discharge medication requirements, and forming a team to determine what type of alert or tool providers wanted. Results: After considering the information gathered from chart checks, provider meetings, and the need for an alert, it was decided that a SmartZone alert would be designed and built. A SmartZone alert and an associated mPage would include a checklist to guide the providers to order the correct medications (and other follow-up). The results reflected in this paper stem from the analysis phase of the project; no implementation results are available as this project is currently awaiting governance approval to continue. Conclusions: The lack of a standard workflow or guide for medication prescribing after a cardiac procedure or hospitalization highlights the need for a CV alert and tool to ensure all patients receive appropriate guideline-based medications and follow-up care. If the CV alert and tool prove beneficial, utilization in other specialties that must meet national reporting standards could be considered for further endorsement of the interventions in this project.