Quality improvement of nurse-led aftercare to outpatients with coronary heart disease: report of a case study.

QUALITY ISSUE: Improving preventive care for patients with coronary disease can be difficult to implement effectively with available resources. Assessing the implementation of a new improvement program can also be challenging when resources are constrained. INITIAL ASSESSMENT: In 2006, a nurse-led outpatient clinic was introduced in the hospital. CHOICE OF SOLUTION: The use of quality indicators (QIs), interviews and regular meetings to enable ongoing assessment of the success of implementation. IMPLEMENTATION: Quality improvement was promoted by providing regular reports on QIs to the CARDIOCARE Steering and Working group. Interviews with stakeholders were held, medical records were investigated and minutes of meetings were analyzed. The main change in CARDIOCARE concerned the targeted patient group. EVALUATION: CARDIOCARE performed well in meeting requirements of quality such as clinical effectiveness. There is, however, still room for improvement and some new QIs should be considered by stakeholders; for example, better registration of risk factors is needed. LESSONS LEARNED: An initial period of time is necessary to examine whether QIs stated in the care protocol are realistic in clinical practice and whether it is feasible to collect data about these criteria. Stakeholders should communicate about these indicators on a regular basis. A Plan-Do-Check-Act cycle is needed in order to improve care processes and performance. In addition, systematic administration of data about indicators is required. For nurse-led outpatient secondary prevention, it is advisable to appoint a single nurse as a case manager who is responsible for checking the registration of QIs and their evaluation.