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Improving EKG Monitoring on the Inpatient Psychiatric Unit
Radu Iliescu MD, Samuel Sheffield MD, Jennifer Leavitt MD, Asia Peek MD MBA MPH, Joonhee Cho MD, Elizabeth LaSalvia MD, Rohn Friedman MD
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Introduction/Problem
The Interventions
Patients with serious mental illness are at increased risk for metabolic syndrome and cardiovascular
disease and have a higher relative risk of death from cardiovascular disease.
➢ Solicited input from Deac 4 staff and EKG clinical manager to understand the EKG recording process.
➢ Intervention #1 (weeks 16-32): Determined that obtaining a Deac 4 EKG machine with automatic
uploading of EKGs into OMR would be a high impact, attainable intervention – hospital-wide EKG
machine renewal was already planned.
Many psychiatric medications, especially atypical antipsychotics, can cause or exacerbate cardiovascular
and metabolic conditions by increasing the risk of weight gain, dyslipidemia, and insulin resistance.
Additionally, many psychiatric medications can increase the risk for arrhythmias. Patients with SMI
receive less screening and fewer preventive medical services compared with the general population.
Studies report potential benefit in obtaining EKGs for the purpose of risk stratification and ongoing
monitoring when prescribing these medications.
Problem #1: Screening EKGs on the inpatient psychiatric unit were inconsistently obtained and
not readily available for review due to an unclear and convoluted process.
Problem #2: There was no standardized way to determine when to order screening EKGs on the
inpatient psychiatric unit.
FRONT OF CARD
BACK OF CARD
➢ Intervention #2 (weeks 24-32):
reviewed the best available
literature and developed
EKG Guide Cards to assist with
the decision of ordering screening
EKGs on admission to inpatient
psychiatric unit (Deac 4).
Results/Progress to Date
Aim/Goal
AIM Statement #1: To improve the percentage of EKGs completed and available for review by MDs
within 24 hours on Deaconess 4 to 85% before April 1 st 2019.
AIM Statement #2: To improve the percentage of EKGs ordered for patients who may benefit from
screening on admission to 90% by April 1 st 2019.
Hyperlink to Process Map
The Team
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Jennifer Leavitt, MD (Psychiatry Resident)
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Asia Peek, MD (Psychiatry Resident)
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Samuel Sheffield, MD (Psychiatry Resident)
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Joonhee Cho, MD (Psychiatry Resident)
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Radu Iliescu, MD (Psychiatry Resident)
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Kari Phillips, RN,BSN (Deac 4 Unit Based Educator)
Marianne Blander (EKG Clinical Manager)
Leah Schweitzer, MD (Inpatient Psych Attending)
Liliana Smurawska, MD (Inpatient Psych Attending)
Rohn Friedman, MD (QI Project Supervisor)
Elizabeth LaSalvia, MD (QI Project Supervisor)
Fig. 1 Effect of introducing machines with automatic EKG uploading on the rates of timely EKG completion,
timely EKG uploading into OMR, and availability of EKGs for review.
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Hyperlink for Process Map
For more information, contact:
Radu Iliescu MD, Psychiatry Resident (riliescu@bidmc.harvard.edu)
�Improving EKG Monitoring on the Inpatient Psychiatric Unit
Radu Iliescu MD, Samuel Sheffield MD, Jennifer Leavitt MD, Asia Peek MD MBA MPH, Joonhee Cho MD, Elizabeth LaSalvia MD, Rohn Friedman MD
More Results/Progress to Date
Fig. 2 Run chart showing the effect of the new EKG machines on the rates of timely EKG completion and
timely EKG uploading into OMR.
Fig. 4 Time from order to completion for the 22 STAT EKGs ordered during the study period (Aug 20 th
2018 – Mar 26th 2019) – only 3 STAT EKGs (not outliers) were obtained using old EKG machines
Lessons Learned
➢ The new EKG machines (high impact intervention) were much more successful at improving patient
care than the EKG Guide Cards (low-impact intervention).
➢ Working on this project led to detection of shortcomings in the process of obtaining STAT EKGs.
Next Steps
➢ Will perform additional PDSA cycles to further improve the timely completion of EKGs on Deac 4 and
to improve patterns of EKG ordering; higher-impact interventions will be considered (e.g. intervention
in POE).
➢ Additional departments will be included in this ongoing QI work (e.g. Cardiology, Billing Department).
➢ Additional quality improvement work will be dedicated to decreasing time of obtaining STAT EKGs on
Deac 4.
Fig. 3 The effect of introducing EKG Guide Cards on patterns of EKG ordering for patients admitted to the
inpatient psychiatric unit (Deac 4).
For more information, contact:
Radu Iliescu MD, Psychiatry Resident (riliescu@bidmc.harvard.edu)
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Radu Iliescu (<a href="mailto:riliescu@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">riliescu@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jennifer Leavitt
Asia Peek
Samuel Sheffield
Joonhee Cho
Radu Iliescu
Kari Phillips
Marianne Blander
Leah Schweitzer
Liliana Smurawska
Rohn Friedman
Elizabeth LaSalvia
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Improving EKG Monitoring on the Inpatient Psychiatric Unit
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness