A Quality Improvement Initiative for Increasing Cardiac Rehabilitation Referrals Using Plan-Do-Study-Act (PDSA) Methodology

Abstract

Background: Cardiovascular rehabilitation has been shown to improve morbidity and mortality in patients with cardiac illnesses; however, the referral rate for eligible patients at Tulane Medical Center has remained below best practice standards.

Methods: This is a single-center, quality-improvement study conducted from January 2020 through December 2020, with historical controls from 2019. Using Plan-Do-Study-Act cycle methodology, interventions were designed to improve referral rates for cardiac rehabilitation-eligible patients. Interventions included a presentation about the importance of cardiac rehabilitation and the current state of referrals, weekly reminders to residents and fellows on inpatient services with eligible patients, and an admission order set that included a default order for cardiac rehabilitation.

Results: The primary outcome was referral rate, which was measured by the total number of referrals compared with the total number of patients eligible for cardiac rehabilitation. In this quality-improvement study of 770 patients, there was a significant increase in the referral rate for cardiac rehabilitation-eligible patients. When comparing the referral rate in 2020-following institution of quality-improvement interventions-with that from 2019, there was an increase from 27% to 70%.

Conclusions: This quality-improvement study found that various interventions significantly increased the cardiac rehabilitation referral rate through a straightforward and simple strategy. Further efforts are underway to promote additional referral in order to meet or exceed the >90% best practice standard.

Keywords: Cardiac rehabilitation; Quality improvement; Referrals.