Use of Plan Do Study Act Cycle to Enhance Timely Care for Patients Presenting to Emergency Department for Cardiac Implantable Device Interrogation

Abstract

Background: The Plan Do Study Act (PDSA) quality improvement methodology is designed to achieve real-world change by repeated practice-improvement cycles. A learning curve exists to commitment to numerous cycles in order to achieve optimal change. Delays in Emergency Department patient flow is often a systems quality issue. This includes arranging interrogation of cardiac implantable electronic devices (CIEDs). Our objectives were to reduce time from admission to CIED interrogation by 75% within six months and to develop experience in utilising PDSA cycle methodology for improving practices in a clinical setting. Methods: A baseline was created with 46 consecutive de-identified patients for planning and documenting baseline times. Following initial planning the first PDSA cycle was based on an individual referral received. The subsequent four referrals constituted the next cycle. The cycles were then expanded to monthly. Process changes were enacted following data review after each cycle. Time to interrogation was measured in the final cycle. Rate of potentially inappropriate CEID interrogation referrals was used as an unintentional outcome measure. Results: 32 patients were seen over the intervention period with a subset of 18 in the final cycle. At six months post intervention there was a 76% improvement in the mean- time (minutes) from admission to CEID interrogation (552 vs. 130, p < 0.01). There was no evidence of increased inappropriate referrals. Core principles of the PDSA cycle were correctly followed. Conclusion: Use of the PDSA cycle methodology achieved significant improvement in the timeliness of patient care over a short time scale without additional resourcing.