The Intersection of Quality and Clinical Care: Approach to Improve Ventricular Assist Device Patient Care

Abstract

Background Improving outcomes in the Ventricular Assist Device (VAD) patient population is an on-going challenge. Incorporating comprehensive quality into a VAD program ensures not only meeting accreditation standards, but helps improve patient care. We used performance measure data to identify deficiencies and garner stakeholder buy-in with the intended goal of improving care. Methods The quality specialist worked closely with the VAD team to identify the performance measures for the program as well as establish benchmarks using evidenced based best practices. Each performance measure was distinctly tied to a data point that would subsequently be abstracted from the chart for each patient. The quality specialist and VAD Coordinator then incorporated the quality measures and performance goals into a QAPI Plan and encouraged stakeholders to review and provide feedback. By engaging stakeholders to review and revise, we promoted buy-in to the QAPI elements of the VAD program. Performance measures were tracked monthly. Variance on the scorecard was presented to the VAD multidisciplinary team as well as Hospital Quality Council. If variance occurred, performance improvement activities were developed. Results A unique color-coded QAPI scorecard was created in which different colors represented different levels of compliance. The metrics were tracked using the Scorecard and presented at the monthly meetings. At baseline, driveline dressing change compliance was 63%. After implementation of our improvement measures, compliance increased to 81%. Similarly, performance of Daily Weights increased from 36% to 96%. Documentation of Nursing VAD Education increased from 57% to 97% and documentation of Pain Assessment increased from 64% to 97%. We maintained a zero percent rate of driveline infection. Conclusion Creating stakeholder awareness of gaps in performance increased commitment to performance improvement plans. Use of a unique color coded QAPI scorecard can be useful in improving quality metrics and subsequently patient care. This approach can be utilized beyond the VAD population to improve quality among all heart failure and transplant patients.