People die each year of cardiac related health problems. Some die of heart attacks and others of congestive heart failure and so forth. This research proposal highlights five peer reviewed journal articles that show how to improve, step-by-step, the infrastructure of a hospital cardiac program. Quantitative data from the studies along with in-hospital data will reveal the need for quality improvement as well as how successful certain methods are when implemented among specific populations. Information was gathered through the search engine Google Scholar and PubMed. All articles are less than four years old and reveal ways to not just improve the safety and care of patient’s but also how to improve surgical outcomes and enhance IT infrastructure, all of which are essential to running a great hospital cardiac program.

Introduction

Several patients in (Hospital Name) have come in complaining of cardiac related health problems. Some have had issues with cardiothoracic surgery from Redo-Sternotomy, Stage 1 Elephant Trunk Procedures. The mission of any hospital or healthcare facility is to create a healthcare program that facilitates patient rehabilitation and recovery as well as provide an excellent quality of care. Several hospitals have improved their quality of care programs with some focusing on cardiac problems and cardiac surgery. The (Hospital Name) has ensured quality of care for its patients for decades, yet there is always room for improvement.

This research proposal will focus on five key areas where the cardiac program can improve upon. The in depth literature review will explain these areas: cardiac rehabilitation, ensuring quality and patient safety, and so forth through peer reviewed journal articles and studies done within the last four years. The articles will not only highlight proven and effective methods of improvement, but will also yield valuable insight on potential problems facing an improvement endeavor such as this.

Many patients with cardiac problems suffer from stroke and while in the hospital can experience re-intubation complications and nosocomial infections. That is why patient safety is a part of an excellent quality of care model and will be heavily emphasized throughout this research proposal. Additionally, patients often have cardiac problems because of poor diet and lack of exercise. Explaining a succinct and concise post-operative eating and exercise plan can be a great addition to any cardiac program.

Problems Statement

Based on the above discussion, it is potentially viable to ascertain a two-fold problem that will function as a point of retreat for the current examination. As has been noted in the introduction and is elucidated in the later review of literature section, one problematic area is the fact that many patients face numerous hurdles that can influence their overall state of health. Some adults are able to overcome such obstacles through self-learning or nurse and doctor information, while others find themselves less well prepared to manage with such trepidations. The second problem area comprises of better understanding of why some patients are quick to learn while others do not as this can be applied to improving the very important aspect of health programs, patient safety and well-being.

Purpose

1. To build a best-in-class hospital cardiac program quality infrastructure.

2. To improve patient safety and patient knowledge.

3. To improve patient rehabilitation and recovery.

4. To minimize surgical complications.

Hypotheses

Based on a review of literature discussed later in this proposal, two major hypothesis areas will direct the exploration of data. First, it is hypothesized that surgical complications can be minimized through proper staff training, including improvement in hand hygiene and procedure guidelines. Patients who report a high degree of complications or infections will tend to have lower insights of higher self-directed enthusiasm leading to an increase in complications and mortality. However, research based approaches will allow for medical staff to reduce likelihood of complications and infection and in the case of such occurrence happening can educate the patient in reducing such instances while leading patients to improved cardiac rehabilitation. Secondly, it is hypothesized that subjects from a community sample will tend to establish higher self-directed enthusiasm than experiencing prolonged hospital stays. And finally, improvement in IT infrastructure will result in increased readiness and ability to handle patients more efficiently and effectively.

Definition of Key Terms

Cardiac cycle – complete heartbeat consisting of contraction & relaxation of both atria & both ventricles

Cardiac output – volume pumped from one ventricle in 1 minute; usually measured from the left ventricle

Conduction myofibers – cardiac muscle cells specialized for conducting action potentials to the myocardium; part of the conduction system of the heart; also called purkinje fibers

Diastole – relaxation phase of the cardiac cycle; opposite of systole

Semilunar valve – valve between a ventricle of the heart and the vessel that carries blood away from the ventricle; also pertains to the valves in veins (Tubaro & European Society of Cardiology, 2011, p. Appendix).

Stroke volume – volume of blood ejected from one ventricle during one contraction; normally about 70 milliliters

Systole – contraction phase of the cardiac cycle; opposite of diastole

Review of Literature

Cardiac Rehabilitation

In an article by Grace et al., the authors discuss the Canadian Cardiovascular Society (CCS) and its implementation of the Canadian Heart Health Strategy and Action Plan recommendation to construct information substructure, through its Data Dictionary and Quality Indicator (QI) project. “CCS selected cardiac rehabilitation (CR) and secondary prevention as a content area for QI development. In accordance with the CCS QI Best Practice Methodology, rapid reviews of the literature were conducted” (Grace et al., 2014, p. 945). Their endeavor to implement such recommendations helps lend vital information on ways to augment the hospital cardiac program. More often than not, hospitals fail to recognize specific needs of care in regards to cardiac rehabilitation. They simply perform procedures and send the patients home after some recuperation. However, patients need more in terms of rehabilitation than traditionally anticipated.

“A long list of 37 QIs, in the areas of structure, process and outcome were developed. Through an online survey, 26 (42%) of all contacted external experts rated each QI on importance, scientific acceptability, and feasibility, using a 7-point scale. The overall mean rating was 5.4±1.4” (Grace et al., 2014, p. 945). Input from the community in the study revealed some key points pertaining to rehabilitation. These key points consisted of five requested QIs by CCS, which are: “(1) Inpatients referred to CR, (2) wait times from referral to CR enrollment, (3) Patient self-management education, (4) Increase in exercise capacity, and (5) Emergency response strategy” (Grace et al., 2014, p. 945). Information conversion undertakings are now happening to encourage employment of the QIs since these are not only commonly requested but also necessary to improve the health of patients.

Patient self-management is an important part of long-term rehabilitation. For cardiac programs to provide excellent quality of care, this area must be well developed. Patient education can be the most powerful tool for recovery and as shown in the article, very requested. Patients want to take care of themselves and possesses the knowledge to do so. Therefore any successful cardiac program must incorporate this.

Ensuring Quality and Patient Safety

In an article by Elliot, the author seeks to improve quality assurance and patient safety. The author highlights several ways hospitals may behave poorly in terms of behavior towards patients. “Hospitals may fail to use information correctly in several ways; inappropriate collection, poor validation, lack of appropriate analysis and the absence of transparency” (Elliott, 2012, p. 5). Many times hospitals are understaffed or handle an excess of cases and the quality of care diminishes. This cannot happen in a cardiac program and must be avoided.

Elliot explains another hurdle in achieving excellent quality of care is funding. “Purchasers and users of care can drive the demand for better data, but the underlying infrastructure requires adequate funding” (Elliott, 2012, p. 5). Often time’s hospitals need adequate funding to promote the necessary research and implementation of guidelines to avoid poor patient care. It is important to note such difficulties to better manage them.

Quality control is a great method of improving hospital care and performance. “…quality control offers faster, more effective improvement through the transformation cycle. The technology available to us now gives us fresh and exciting opportunities to engage” (Elliott, 2012, p. 5). Technology should be at the forefront of any improvement protocol. As technology increases by leaps and bounds, quality care should be augmented along this avenue. Hardware and software are key parts of such improvements.

Summary

Methodology

Study Setting

Research Design

Population and Sampling Plan

Data Collection Procedures

Data Analysis

Concluding Remarks

Significance

Limitations

References

Elliott, M.J. (2012). The role of information in ensuring quality and patient safety. Progress in Pediatric Cardiology, 33(1), 5-10. Retrieved from http://www.sciencedirect.com/science/article/pii/S1058981311000853

Grace, S.L., Poirier, P., Norris, C.M., Oakes, G.H., Somanader, D.S., & Suskin, N. (2014). Pan-Canadian Development of Cardiac Rehabilitation and Secondary Prevention Quality Indicators Endorsed by the Canadian Association of Cardiac Rehabilitation. Canadian Journal of Cardiology, 30(8), 945-948. Retrieved from http://www.sciencedirect.com/science/article/pii/S0828282X14002335

Guillamondegui, O.D., Gunter, O.L., Hines, L., Martin, B.J., Gibson, W., Clarke, C., Cecil, W.T. (2012). Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes. Journal of the American College of Surgeons, 214(4), 709-714. Retrieved from http://www.sciencedirect.com/science/article/pii/S1072751511013287

IEEE Conference on Software Engineering Education and Training, & IEEE Computer Society. (2011). Educating software engineers of the future: Software quality research through problem-based learning. In CSEE&T 2011: Proceedings (pp. 91-100). Los Alamitos, California: IEEE.

Naydenova, I., & White, B. (2013). Enhancing the IT Infrastructure at Saint Philip’s Hospital: Point-Of-Care Solutions. Information Systems Education Journal, 11(5), 35-49. Retrieved from http://isedj.org/2013-11/N5/ISEDJv11n5p35.html

Tubaro, M., & European Society of Cardiology. (2011). The ESC textbook of acute and intensive cardiac care. Oxford: Oxford University Press.