BMH was the first hospital in South Carolina to participate in GWTG beginning in August 2002. In the fourth quarter of 2002, the hospital hired a Core Measure Coordinator who reported to the Director of Vascular Health. We collected data on 100% of our patients discharged in 2002, in order to establish a true baseline practice. Our Core Measure Coordinator developed a Core Team with a physician champion. Included on our team were the Nursing VP, Pharmacy Director, Lab Director, IS Representative, Nursing Clinical Managers, and Nursing Staff.

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In 2004, we developed a medical record "alert sticker" to notify physicians that this was a Core Measure patient and required documentation. Revisions of existing ICU/PCU Admission Orders by adding a prompter for easy ordering of fasting lipids, Ace Inhibitors and Beta Blockers. The Meidcal Staff approved nursing ordering of Cardiac Rehab consults. We revamped the dry erase boards posted on the nursing units to include patient identifier, patient assisgned nurse and physician in an effort to improve communication. Previously assembled Patient Education Folders were readily available on each nursing unit. Several attempts were made to approve a proposed CHF Pathway without success. This is still currently being pursued This was implemented throughout the hospital. Smoking Cessation Patient Education was automated to print when nurse answered "yes" on Initial Nursing Assessment. This prompted nursing to complete patient education on smoking cessation. In addition, Smoking Cessation Education was included in all inpatient admission packets at the time of patient registration. We formulated standing admit orders for the CHF and CAD patients. The Team pursued obtaining complimentary scales from our local discount center. In addition we developed the post discharge call back system to reinforce education completed during the hospital stay and address any patient questions. In Spetember 2005, we held a AHA and GWTGs physician leadership program. Revised the existing Hospital Patient Discharge Instruction Sheet to include the CAD indicators in December, 2005. Distribution of physician Core Measure pocket reminder cards also took place.

The Team implemented a Hospital/Vascular Health Newsletter to communicate data results, comparative data, information on data elements and any new information related to Core Measure to nursing and medical staff. Physician recognition was addressed as well as emphasis on public reporting and the impact on delivery of care. We implemented distribution of a follow up letter to the patients for the purpose of additional education regarding meds, labs, daily weights, and diet. In 2004, we implemented faxing of patient information to physician offices related to their most recent inpatient stay.

Continuous concurrent education is done to closely observe our CHF and CAD indicator results with tracking and trending to identify improvements. The Core Measure Team Members haves been revised as attrition and necessity occurs. The original team needed to meet more frequently and currently is meeting when an issue arises.

Several things that have grossly improved is the organizations awareness of what Core Measures are and what the expectations for the organization.

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Very little additional cost was associated with our improvements. The Medical Staff Dinner and speaker was the larges cost. Secondly, was the cost of printing and letter head paper for letters. Third, was the employee time utilized to design the changes, educate physicians and staff and monitor and report data.

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