Implementing Quality Improvement Measures with the Get With The Guidelines®-Heart Failure Program: Experience at Palmetto General Hospital

In this interview, we speak with Julie Garcia, RN, MSN, Chief Quality Officer from Palmetto General Hospital in Hialeah, Florida, about their cardiac program achieving the American Heart Association’s Get With The Guidelines^®-Heart Failure Gold Quality Achievement Award.

Tell us about the cardiovascular program at Palmetto General Hospital. How many cath/EP labs and staff members are there? 

Our cardiovascular program opened its door to our community over 10 years ago with the inception of the open heart program. The program has grown over the years, and we currently have three cath/EP labs, two open heart rooms, and a hybrid suite for complex procedures such as TAVR (transcatheter aortic valve replacement). In addition to cardiac surgery, there is a full gamut of vascular procedures being done, including minimally invasive stenting of all major blood vessels. There are over 25 employees between the cath/EP lab. In addition, there are over 20 physicians.

What types of cardiovascular procedures are performed at your facility? 

We perform a variety of cardiovascular procedures, including but not limited to the following: cardiac catheterization, complex electrophysiology studies, open heart surgery, minimally invasive valve replacement, TAVR, insertion of permanent pacemakers and ICDs, and peripheral procedures.

Approximately how many heart failure patients does Palmetto General Hospital see annually? 

Over 2,700 patients annually.

Palmetto General Hospital recently achieved the Get With The Guidelines-Heart Failure Gold Quality Achievement Award. What can you tell us about this quality improvement program?

This quality improvement initiative is committed to promoting and achieving significant patient outcome improvement through evidence-based practice and guidelines. It includes hospital-wide education on the care of the heart failure patients for all employees that come into contact with these patients and their families, as well as a robust program that starts on admission and continues throughout the patient’s hospitalization and after discharge from the hospital.

The emphasis is on early recognition, close monitoring, and control of factors that can impact the quality of life for patients that suffer from this disease. Patient and family education is essential so they understand what they can do to improve and manage their health. Some of this education includes medication management, diet, weight monitoring, and very important follow-up care after discharge and support at home. 

Why did your facility choose to participate? 

We participate in the Get With The Guidelines-Heart Failure program because we are committed to improving the quality of health in our community, and we believe that this can be achieved through evidence-based care for our patients and by promoting consistent adherence to the latest scientific treatment and guidelines.

What is the process for participating in the Get With The Guidelines-Heart Failure program? What steps are involved? 

Participation is voluntary for any institution that wishes to participate and is committed to providing quality patient care. We initially assembled a multidisciplinary team of providers to determine what internal changes we needed to make, designed the education to our team, and analyzed the processes we had in place. Data was collected to establish a baseline for future reference as well as to measure or benchmark our success. Processes and protocols were reviewed and redesigned to ensure that they were in line with the guidelines, and improvement strategies were created to improve treatment options. After the initial rollout, we made adjustments as needed and celebrated our successes. Our goal continues to be the same — to provide quality, evidence-based care to our patients and community.

How long did this process take for Palmetto General Hospital? What members of the cardiovascular team were involved? 

The entire cardiovascular team was involved from the beginning, and continues to be engaged. This includes clinical cardiologists, primary care physicians, interventional cardiologists, cardiovascular surgeons, electrophysiologists, allied health practitioners, nurses, etc. The entire team has been instrumental in achieving positive outcomes for our patients. This journey started over 10 years ago and continues today. As new evidence medicine benchmarks are established, we will implement them and continue on as long as it improves the health of our patients.

What are some of the ways your facility’s approach to treating heart failure has changed since enrolling in the Get With The Guidelines-Heart Failure program? 

Since enrolling in the Get With The Guidelines-Heart Failure program, we have changed hospital-wide treatment of our heart failure patients. We provide our patients with current evidence-based education on the signs and symptoms of heart failure, as well as information on medications, diet regimen, and weight control. We monitor their LDL cholesterol levels and provide treatment modalities as needed. We assure that the patients are discharged with follow-up appointments, a scale to monitor their weight, and education on medications and diet regimen. Whenever possible, we make sure that the primary caregiver at home is included in the education process. We also work closely with community agencies and post-acute care providers to educate them so they can achieve better results for our patients.

How has participating in the Get With The Guidelines-Heart Failure program affected your center’s patient outcomes?

Our center’s patient outcomes have improved, as evidenced by the decrease in readmissions for congestive heart failure. Our patients and their families are also reporting better understanding of the disease and its management. 

What does participating in the Get With The Guidelines-Heart Failure program mean for the staff at Palmetto General Hospital? 

Participation in the Get With The Guidelines-Heart Failure program is a commitment to quality. It means meeting Tenet’s mission, which is to help people live better lives.

Is there anything else you’d like to add? 

Commitment to quality is not a program, it’s a lifelong journey that we have embraced and are passionate about. At times, it requires changes in the way we have operated for many years. Change is always challenging, but if you believe in what you’re doing, you make it happen!