Improving Preoperative Cardiac Assessment Efficiency by Using the American College of Cardiology/American Heart Association Guidelines: A Quality Improvement Project

Abstract

Background: Patients undergoing noncardiac surgery can experience cardiac complications, which are a major cause of morbidity and mortality in the perioperative period. The goal of this quality improvement (QI) project was to standardize the preoperative assessment process and improve patient-centered care by implementing evidence-based practice guidelines for electrocardiogram (ECG) recommendations prior to noncardiac surgery. Methods: Three steps were used to implement the American College of Cardiology/American Heart Association (ACC/AHA) recommendation for ECG to reduce variance in practice and decrease surgical cancellations. A pre- and postdesign was used to evaluate 2 outcomes: decreased surgical cancellations for lack of a current ECG and surgical loss opportunity cost. All data were retrospectively collected for 60 days during the pre- and postperiods. Results: Evidence-based, preoperative ECG recommendations were implemented in the electronic medical record (EMR). Overall, ECG guideline adherence increased from 50% to 66% (χ2 = 2.19, p = .139) postimplementation. Surgical cancellations because of unmet ECG requirements were reduced from 50% to 34% (χ2 = 2.19, p = .139) post-EMR guideline implementation. There was no statistical difference in the cost associated with loss surgical opportunity minutes between the periods (t = 0.79, p = .43, 95% CI [−6.96, 16.24]). Discussion: We successfully implemented an evidence-based guideline recommending specific preoperative ECG requirements within a busy Veterans Administration hospital. This project stimulated ongoing dialogue between the disciplines with positive trends in decreased surgical cancellations.