A cooperative approach to standardizing care for patients with AMI or heart failure

In fall 2003 the five hospitals in Wichita, Kansas, formed a collaborative to improve care for patients presenting with acute myocardial infarction or heart failure (HF). Standard order sets were developed from guidelines developed by the American College of Cardiology and the American Heart Association. THE WICHITA CITYWIDE HEART CARE COLLABORATIVE GETS TO WORK: The order sets, which highlighted the appropriate interventions and made their implementation a "checkbox" activity, were placed in the progress note section of the medical record. Booklets for patient education on heart care were developed.

All five hospitals have experienced significant improvement in core measure data. For example, for angiotension-converting enzyme inhibitor for left ventricular systolic dysfunction, the overall compliance score improved from 70% to 85%, a 15% improvement in 18 months. Compliance for HF was perhaps more successful, given the low level of initial compliance (50%).

Physician compliance was enhanced by incorporating the guidelines into practitioners' daily workflow needs, providing prompt feedback on their performance, incorporating their suggestions made at the point of care, and using process measurements.