Bakhai Recognized for Quality Improvement Project

Heart failure is a leading cause of emergency department visits and hospital readmissions.

At Erie County Medical Center (ECMC), Bakhai and other members of the quality improvement team saw that about 15 percent of patients in the Internal Medicine Clinic (IMC) were diagnosed with heart failure, but many other patients were undiagnosed because they were not undergoing echocardiograms.

Echocardiograms are the primary method for diagnosing and classifying systolic heart failure. Without them, heart failure can be misclassified and not properly treated. However, patients failed to undergo echocardiograms because they could not afford them, they had insufficient knowledge about them, or they lacked transportation to appointments.

Physicians in the IMC also saw that administration of guideline-directed medical therapy (GDMT) — a group of medications used to treat systolic heart failure — did not meet American College of Cardiology and American Heart Association standards.

To help solve this problem, the quality improvement team launched its project, “Optimization of Guideline-Directed Medical Therapy for Heart Failure,” with the goal of improving accurate classification of heart failure and increasing GDMT use for patients with systolic heart failure.

Ultimately, the project improved the rate of patients’ echocardiogram completion. 

Further, the quality improvement team was able to increase the recognition of congestive heart failure from a baseline rate of 10 percent to 70 percent.

The project also helped decrease the number of emergency room visits and number of hospitalizations for patients with congestive heart failure, and physicians were able to work closely with patients to make decisions to optimize GDMT. 

To execute the project, the quality improvement team completed Plan-Do-Study-Act (PDSA) cycles, which are frameworks for developing, testing and implementing changes leading to improvement.

“We performed five PDSA cycles. The major components of interventions were to leverage the health information technology; optimize team work; and educate the patients, nursing staff and physicians,” says Bakhai, who practices through UBMD Internal Medicine.

The team created educational posters and brochures for examination rooms to educate patients and to help residents better diagnose heart failure. The posters also prompted physicians to start GDMT when necessary.

Medical staff educated patients about heart failure complications, medication adherence and weight monitoring, and they provided weighing scales to help patients monitor their own weight. A social worker helped patients overcome cost and transportation barriers. Additionally, as part of the project, the clinic created a new position to facilitate care transitions from the hospital to the primary care clinic.

A tracking system was also created for hospital discharges and emergency department visits. “The quality improvement team created an electronic patient registry to follow the heart failure patients and to facilitate the clinic visits from the emergency room visits so the physicians can follow up in a timely manner,” explains Bakhai.

The Gage Awards program honors the outstanding work of America’s Essential Hospitals members.

America’s Essential Hospitals is a leading association and champion for hospitals and health systems dedicated to high-quality care for all. The association has initiated, advanced and preserved programs and policies that help these hospitals ensure access to care. It supports members with advocacy, policy development, research and education.

Through the Gage Awards, the association recognizes members for implementing efficacious improvement projects, and it promotes best practices and innovative programs.

The association aims to identify and disseminate evidence-based best practices that enhance the quality of care for all, especially vulnerable people.

Bakhai and her collaborators were selected as honorable mention recipients by a panel of judges that included leaders from a variety of positions within member hospital organizations, as well as previous award winners and experts in health care quality and population health.

Her collaborators on the project included:

• Aishwarya Bhardwaj, MD, and Huy Phan, MD, trainees in the internal medicine residency who graduated in 2018
• Shane Varghese, MD, a trainee in the internal medicine residency who graduated in 2019

She accepted the award in Miami in late June at VITAL2019, the association’s annual meeting. 

“It is a great privilege to receive this award. ECMC’s mission is to provide the highest quality of care delivered with compassion to every patient,” she emphasized during her acceptance speech.

“Everyone’s commitment to this mission has led to the success of this project. I would like to thank ECMC’s leadership for fostering and exemplifying patient safety and quality,” she said.

“I would like to recognize our resident team leaders, Drs. Bhardwaj, Varghese and Phan for their outstanding contributions to this project,” she added, noting her deep gratitude for the entire quality improvement team of clinical front-line staff, nurses, physicians, case managers, social workers, patients and information technology staff.