Clinical Quality Report


Appropriateness of care focuses on the “right care for every patient, every time.” Care for heart attack inpatients includes all of the following indicators:

Folder: Physicians

1. Aspirin at arrival
2. Aspirin at discharge
3. ACE I or ARB for left ventricular systolic dysfunction
4. Statin at discharge
5. Beta blocker at discharge

Providing the entire bundle of care decreases mortality, re-infarction, and non-fatal strokes. The volume of patients hospitalized at Samaritan for MI care is low since the majority of patients presenting with heart attack are transferred to a tertiary care hospital for intervention in the cath lab. In 2008, Heart Attack Information regarding outpatients was required to also be submitted to CMS and Joint Commission. This OP data better reflects our volumes and treatment plans for heart attack care.

It is estimated that 4.7 million persons have heart failure. Mortality rates are high, and as our population ages, the incidence and mortality are expected to increase. Educating patients with heart failure and their families is critical. Patient non-compliance with discharge instructions is often a cause of re-hospitalization. It is thus important that health care professionals ensure that patients and their families understand the prognosis of heart failure; the rationale for pharmacotherapy; dietary restrictions and activity recommendations; prescribed medication regimen; and the signs and symptoms of worsening heart failure. Additionally, patients discharged from the hospital after an exacerbation of heart failure need follow-up to ensure clinical stability.

Folder: Physicians

There is growing clinical evidence of an association between timely inpatient administration of antibiotics and improved outcome among pneumonia patients. A study of Medicare patients found that 30-day mortality was 10% lower and length of hospital stay was shorter among patients whose first antibiotic was administered within 4 hours compared with those whose time to first dose was longer.

Education has been ongoing with the ED physicians and nursing staff, stressing the importance of obtaining and administering the antibiotic as soon after arrival as possible. Process changes to screen and administer pneumonia vaccination have been implemented to standardize the documentation.

The Surgical Care Improvement Project (SCIP) is divided into various measure categories ranging from antibiotic use to beta blocker use to appropriate hair removal. Our overall score is based on an average of each of the measure sets as listed below. Patients have been shown to have improved outcomes when all of the recommended measures are followed.

Folder: Physicians