Rapid-cycle improvement in quality of care for patients hospitalized with acute myocardial infarction or heart failure: moving from a culture of missed opportunity to a system of accountability.

We describe a 1-year multidisciplinary initiative to improve the quality of care for patients with acute myocardial infarction and heart failure. In January 2002, this rapid-cycle improvement project began with a partnership of inpatient cardiology nursing and physician leadership. This inpatient leadership team analyzed clinical and operational processes, and revised and developed tools such as standard order sets, discharge instructions, clinical pocket guides, and daily monitoring logs. Once the tools and processes, were implemented, the team began "daily monitoring" to assess tool use. At the same time, a process was implemented to provide rapid feedback on key quality indicator compliance within a short time after discharge. At 12 months, quality improvements have been demonstrated.