Abstract 6907: Implementing Quality Improvement With Fellow-in-Training Super Users: Preventing Preventable Strokes Initiative

Abstract

Introduction: Quality improvement (QI) is an integral requirement of post graduate training. To reduce stroke by addressing lack of anticoagulation (AC) for patients with atrial fibrillation (AF), the Heart Rhythm Society (HRS) led QI initiatives at metropolitan area “safety-net” hospitals, health systems that deliver a significant level of service to medically and socially vulnerable populations. We incorporated a fellow-in-training “Superuser” team in the design of a QI initiative at University of Florida Health Jacksonville. Hypothesis: Our hypothesis was that the use of a team of fellows in training to conduct academic detailing can enhance the impact of QI intervention Methods: This initiative was designed to integrate guideline-based treatment algorithms and alerts into the Electronic Health Record (EHR) and to disseminate education for the provider and patient, with emphasis on shared-decision making. An interdisciplinary team was organized among divisions of cardiology, internal medicine, family medicine, information technology and pharmacy. The first stage was to collect benchmark data to identify gaps in guideline-directed AC. EHR records from July through December 2020 were reviewed. To assist with PDSA (Plan, Do, Study, Act) interventions, a Superuser team was formed by fellows-in-training in cardiology and electrophysiology, as well as residents in internal medicine. The information technology department generated bi-weekly data reports to monitor progress. Bi-weekly Superuser meetings were held to analyze data, identify improvement strategies, and form a plan of action. A total of five PDSA cycles were planned and conducted over a 6-month period. Results: At benchmark, 43.67% of AF patients with a CHA 2 DS 2 -VASc score of 2 or more were untreated with AC. This percentage was reduced to 42.16% after five PDSA cycles. There were 1.5% more patients treated with AC after six months, compared to the benchmark data. This improvement in AC percentage could have resulted in the prevention of 1.5 strokes. Conclusion: Appropriate and sustained interventions can improve quality measurement in guideline-based AF management. Fellows-in-training can be mobilized to support these efforts. The QI initiative achieved some success and built a foundation for future outcomes-based improvement, as well as an enthusiasm for QI by fellows-in-training.