Reduction of Erroneous ST-segment Elevation Myocardial Infarction Diagnoses: A Successful Nurse-led Quality
John Porter1, Aaron B Klassen2, Julie A Chesney3
1Cardiac Catheterization Laboratory.
Insights
A nurse-led quality improvement project reduced incorrect ST-segment elevation myocardial infarction diagnoses, a critical heart condition, from 24% to 7%. This initiative enhanced patient safety and improved diagnostic accuracy in electronic health records.
Area of Science:
- Cardiology
- Health Informatics
- Quality Improvement
Background:
- ST-segment elevation myocardial infarction (STEMI) is a severe acute coronary syndrome with significant health implications.
- Inaccurate STEMI diagnoses in electronic health records (EHRs) can lead to patient risk via poor assessment and care.
- An EHR shortcut for emergent cases was identified as a potential cause of diagnostic errors.
Purpose of the Study:
- To address and reduce erroneous STEMI diagnoses within institutional discharge records.
- To implement a quality improvement project to correct diagnostic inaccuracies.
- To minimize disruption to clinical practice while enhancing patient safety.
Main Methods:
- A retrospective review of EHRs identified diagnostic assignment patterns.
- A nurse-led quality improvement project utilized the Define, Measure, Analyze, Improve, Control (DMAIC) framework.
- Interventions focused on correcting the misapplication of EHR shortcuts.
Main Results:
- The percentage of patients with erroneous STEMI diagnoses decreased significantly from 24% to 7%.
- Nursing staff satisfaction showed marginal improvement.
- The project successfully addressed an institutional quality concern regarding diagnostic accuracy.
Conclusions:
- Nurse-led quality improvement initiatives can effectively reduce diagnostic errors in acute coronary syndrome.
- Addressing EHR system flaws and involving frontline staff are crucial for successful quality improvement.
- The project achieved its goal of reducing erroneous discharge diagnoses, improving patient care outcomes.
Abstract:
An ST-segment elevation myocardial infarction is a life-threatening condition within the spectrum of acute coronary syndrome, with well-recognized implications for short-term and long-term health outcomes. Retrospective review of our institutional electronic health records identified patterns of inaccurate acute coronary syndrome diagnostic assignment, including the presence of erroneous ST-segment elevation myocardial infarction diagnoses in discharge records. Such erroneous diagnoses in the durable health record may increase risk to patients through inadequate risk assessment and inappropriate follow-up care. Misapplication of a shortcut in our electronic health record system for rapidly ordering emergent cases was identified as a potential cause of the quality gap. To address this issue, a nurse-led quality improvement project was developed by using the define, measure, analyze, improve, and control framework. The project intervention decreased the percentage of patients with erroneous diagnoses from 24% to 7% and marginally improved nursing staff satisfaction. Our project successfully addressed an institutional quality concern. Our goal of reducing erroneous discharge diagnoses with minimal disruption to our existing practice was achieved, positively affecting our patients. Including both nurse leaders and frontline health care workers ensured the success of our project.
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