The development of an order set for adults admitted for acute heart failure at a National University Hospital in the Philippines
https://doi.org/10.47895/amp.vi0.8404
- Author:
John Vincent U. Magalong
1
,
2
;
Felix Eduardo R. Punzalan
3
;
Marie Kirk Patrich A. Maramara
4
;
Frederick Berro B. Rivera
5
;
Zane Oliver O. Nelson
3
;
Bai Sitti Ameerah B. Tago
3
;
Cecileen Anne M. Tuazon
3
;
Ruth Divine D. Agustin
6
;
Lauren Kay M. Evangelista
3
;
Michelle Marie Q. Pipo
3
;
Eugenio B. Reyes
4
;
John C. Añonuevo
3
;
Diana R. Tamondong-Lachica
1
,
7
Author Information
1. Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
2. College of Medicine, San Beda University, Manila, Philippines
3. Division of Cardiovascular Medicine, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
4. Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
5. Department of Medicine, Lincoln Medical Center, The Bronx, New York (NY ), USA
6. Department of Health, Philippines
7. College of Medicine, University of the Philippines Manila, Manila, Philippines
- Publication Type:Journal Article
- Keywords:
Acute heart failure;
Order set
- MeSH:
Quality Improvement;
Critical Pathways
- From:
Acta Medica Philippina
2024;58(Early Access 2024):1-12
- CountryPhilippines
- Language:English
-
Abstract:
Background and Objectives:Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes.
Methods:This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given.
Results:Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus.
Conclusion:The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.
- Full text:20240619131329398668404-Article Text-161533-1-10-20240611.pdf
