Document Detail


Barriers to implementing a surgical beta-blocker protocol.
MedLine Citation:
PMID:  16335065     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Experience with a quality improvement (QI) program undertaken to increase the use of beta-adrenergic blockade in at-risk patients at both a major academic medical center and a community hospital suggests barriers to implementation. METHODS: A retrospective and prospective cohort study was performed to establish the incidence and effectiveness of beta-blockade use pre- and postimplementation of a standardized screening tool and a major education program as part of a QI project. Data gathering involved a baseline phase pre-intervention; 6 weeks postintervention; and 3-6 months postintervention. RESULTS: During phase I (baseline) 56% of eligible received beta-blockers, but targeted measures (a pre-induction heart rate < 70 or a systolic blood pressure [BP] < 110 mmHg) were achieved in only 11% of patients. Phase II saw a significant overall increase in beta-blocker administration (79%) and efficacy (50%). However, during phase III (3-6 months postimplementation), the rate of beta-blocker administration fell to 61% overall, while overall efficacy remained stable at 52%. Significant differences between the academic and community hospitals were observed throughout the study. CONCLUSION: Implementation of a quality program for beta-blockade is significantly affected by the presence or absence of ongoing physician and staff education beyond the study period.
Authors:
Michael N Cantor; Valentina Lavarias; Steven Lam; Lauren Mount; Violetta Laskova; Vadim Nakhamiyayev; Yakov Bier; Dino Paiusco; Anthony C Antonacci
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Joint Commission journal on quality and patient safety / Joint Commission Resources     Volume:  31     ISSN:  1553-7250     ISO Abbreviation:  -     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-12-09     Completed Date:  2006-01-31     Revised Date:  2006-08-28    
Medline Journal Info:
Nlm Unique ID:  101238023     Medline TA:  Jt Comm J Qual Patient Saf     Country:  United States    
Other Details:
Languages:  eng     Pagination:  640-8     Citation Subset:  IM    
Affiliation:
Department of Medicine, Beth Israel Medical Center, New York City, NY, USA. michael.cantor@med.nyu.edu
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers
Adrenergic beta-Antagonists / administration & dosage,  therapeutic use*
Cardiac Output, Low / drug therapy
Clinical Protocols*
Cohort Studies
Diffusion of Innovation*
Dose-Response Relationship, Drug
Hospitals, Community
Humans
Postanesthesia Nursing*
Prospective Studies
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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