Measuring and Improving Inpatient
By Sandra Fuller, RN
The American Heart Association and
the American Stroke Association have developed a new in-hospital,
quality-improvement program called Get
With the Guidelines. The program won the “2004 Innovation in Prevention
Award” from Health and Human Services, as part of the federal government’s
current initiative to prevent chronic diseases among Americans and improve
quality of life.
Cayuga Medical Center Cardiac Care
Services is enrolled in Get With the Guidelines (GWTG). To be eligible to
participate in GWTG a hospital cardiac-care program must be well established
and accredited, and must have in place certain standard treatment protocols
that all cardiac-care providers understand and follow. The hospital must also
have sophisticated data-management capabilities for tracking both adherence to
quality initiatives and patient outcomes. This capability facilitates the
sharing of data among participating hospitals for the purposes of measuring performance.
How does Get With the Guidelines
help improve cardiac care?
This national program helps improve
in-hospital cardiac care in several ways:
First, the program promotes
evidence-based treatment protocols for patients with coronary artery disease
and heart failure in the hospital setting.
Second, it helps to assure that all
doctors responsible for treating cardiac patients – in the Emergency
Department, in the Intensive/Coronary Care Unit, and in the inpatient
medical-surgical units – are up to date on the very latest approaches to
treatment. The educational component of GWTG is constantly updated to provide
the most current information.
Third, the program measures
compliance at the time care is being delivered. The software enables us to
provide immediate feedback to doctors and nurses on their individual adherence
to recommended treatment guidelines.
Fourth, the program emphasizes
prevention of secondary events, such as another heart attack or
rehospitalization for chronic heart failure.
How is being part of the GWTG
national database helpful?
As part of the GWTG national
database, the caregivers at Cayuga Medical Center can compare our care to other
hospitals. The American Heart Association gives us feedback on how we are doing
on every aspect of cardiac care, from the time a patient comes through the
doors of the Emergency Department to time of discharge. Many different
departments within the hospital are involved in caring for cardiac patients and
GWTG helps to create a cardiac-care team across all of these individual
Another benefit to participating in
GWTG is the sharing of information from hospitals across the country about the
best processes for improving current services and for implementing new
services. This helps participating hospitals from having to reinvent the wheel
and enables them to avoid methods that don’t work. Participating hospitals are
also assisted by GWTG in complying with accreditation requirements for the
Joint Commission on Accreditation of Healthcare Organizations (JACHO).
Additionally, Get With the
Guidelines enables us to track data in many different fields. For example, we
can look at cardiac care by gender and age and treatment plan. All of this
helps us identify potential areas for improvement within specific cardiac
Hospitals are very focused on
performance improvement initiatives, which have the potential to improve
patient care and outcomes. However, quantifiably measuring the impact of these
initiatives can be difficult. GWTG is a very helpful tool in this regard.
According to the American Heart Association, many more lives could be saved
each year if the Get With the Guidelines program was implemented nationwide.
As we expand Cardiac Care Services
at Cayuga Medical Center in the coming years, we want to ensure that the
foundation upon which we build is of the highest quality. Get With the
Guidelines is just one more tool to help us provide excellent cardiac care to
the community we serve.
Fuller, RN, is director of Cardiac Care Services at Cayuga Medical Center. She
works closely with cardiac-care medical director, cardiologist Dr. Malcolm
Brand, FACC, and a team of board-certified cardiologists and experienced
cardiac, emergency, and intensive care nurses.