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Cardiology physicians discuss implementation of GWTG program by Heather Woolwine Public Relations Evaluating the quality of patient care requires outcome managers to step back in time and assess what happened with patients who were in the hospital, but who may not be anymore. Physicians, nurses and outcome mangers from the departments of cardiology and quality management want to change that retrospective approach.   As the keynote speakers at a recent South Carolina American Heart Association (AHA) chapter statewide meeting in Columbia, Peter Zwerner, M.D., Cardiology, and Natalia Luna Maffei Corica, M.D., Cardiology outcomes manager, presented information that not only described the cost effectiveness of quality care, but also how an AHA Web-based tool could improve the rendering of patient care through a real time approach.   The meeting was based on how different institutions planned to implement the AHA’s Get With The Guidelines (GWTG) program, and MUSC was chosen to discuss the science behind the guidelines MUSC’s plan for implementation of those guidelines.     Dr. Peter Zwerner “This initiative is one way in which we are contributing to excellence,” Zwerner said. “Based on a patient’s diagnosis, coronary artery disease or heart failure, the clinical team can make care recommendations on a variety of topics, from the type of medications a patient takes to smoking cessation. If a patient varies from the recommended AHA guidelines, then staff can look closely at that patient and determine the reasons for that variation. There are often appropriate reasons, but we just want to make sure nothing falls through the cracks. It’s important to put systems that ensure our patients receive the best quality of care while they are in the hospital.”     The multidisciplinary quality initiative team is using the AHA GTWG program geared towards preventing second heart attacks in patients with coronary artery disease or heart failure to maximize appropriate therapies for patients with these diagnoses. A systematic outcome-based program, it employs Web tools for entering and tracking patient information and examining MUSC’s performance against national standards.   Dr. Natalia Luna Maffei Corica In addition to commending Zwerner’s championship of the initiative, Luna Maffei Corica said, “Not only is it important to render the best medical care, but we also want to use the tool as educational material for the clinical team so they in turn can educate the patients about their condition and how best to treat it. With this patient management tool, we will strive to surpass the stringent AHAs benchmark for best cardiology care by real-time evaluation of medical care throughout our patient’s hospital stay. We not only intend to render the best medical care, but also educate physicians and nurses in training about the latest cardiology guidelines and inform our patients on their conditions. Dr. Eric Powers, the medical director for our PCU, has also been instrumental in planning and implementing this initiative.”   Members of the cardiology clinical team include Mary Beth Crummer, R.N., 9PCU nurse manager; Christine Mancine, R.N., patient educator; Caroline Vaughn, R.N.; and Patricia Cadanach, R.N.   These members use Web tools to enter data not for retrospective analysis, but to offer a different perspective that allows a look at patient data in real time for comparison with GTWG guidelines. The team enters individual patient data daily into the secure AHA GWTG Web-based tool to ensure total compliance each day of the patient’s hospital stay. The idea is that staff will be able to render an even better quality of care by making changes, if needed, concurrent to a patient’s stay in the hospital, thus improving care while the patient is still in the hospital. The Web tool also prompts explanations of the guidelines and educates staff on what’s appropriate care for each patient and why. Staff has the ability to print tailored patient education information and to generate referral letters.   “Our goal is 100 percent compliance for outcome-based assessments within the AHA guidelines,” Luna Maffei Corica said. “Its also important for people to know that this is not about putting more on people’s plates or taking physicians or nurses away from their critical care duties; instead, this is meant to replace the old way of doing things. It’s a new and better way to render care.” Quality care is cost effective Evidence supports that adhering to guidelines reduces short term re-admissions by at least 10 percent. Evidence that a better-mapped care process and staff communication reduces patient length of stay (LOS). A one-day reduction in LOS has an associated savings of $1,500 to $3,000. Better patient communication means higher patient satisfaction. GWTG is proven to increase adherence to key indicators. These will improve the “hospital grade” on report cards. Can empower nurses, lead to higher nursing retention rates. Future health plan preferred reimbursement rates likely. A cultural shift to system improvement and team accountability that spreads throughout the hospital. Lower rates of patient mortality and complications. Higher compliance with regulatory agencies like JCAHO.     Friday, Dec. 8, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.