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Barriers to Implementing a Surgical Beta-Blocker Protocol

2005; Elsevier BV; Volume: 31; Issue: 11 Linguagem: Inglês

10.1016/s1553-7250(05)31082-8

1938-131X

Michael Cantor, Valentina Lavarias, Steven Lam, L Mount, Violetta Laskova, Vadim Nakhamiyayev, Yakov Bier, Dino Paiusco, Anthony C. Antonacci,

Blood Pressure and Hypertension Studies

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. 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. During phase I (baseline) 56% of eligible patients 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. 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.