Guidelines/Clinical Documents: In hospitals, improvers and implementers use quality improvement science (QIS) and less frequently implementation research (IR) to improve health care and health outcomes. Narrowly defined quality improvement (QI) guided by QIS focuses on transforming systems of care to improve health care quality and delivery and IR focuses on developing approaches to close the gap between what is known (research findings) and what is practiced (by clinicians). However, QI regularly involves implementing evidence and IR consistently addresses organizational and setting level factors. The disciplines share a common end goal, namely, to improve health outcomes, and work to understand and change the same actors in the same settings often encountering and addressing the same challenges. QIS has its origins in industry and IR in behavioral science and health services research. Despite overlap in purpose, the 2 sciences have evolved separately. Thought leaders in QIS and IR have argued the need for improved collaboration between the disciplines. The Veterans Health Administration’s Quality Enhancement Research Initiative has successfully employed QIS methods to implement evidence-based practices more rapidly into clinical practice, but similar formal collaborations between QIS and IR are not widespread in other health care systems. Acute care teams are well positioned to improve care delivery and implement the latest evidence. We provide an overview of QIS and IR; examine the key characteristics of QIS and IR, including strengths and limitations of each discipline; and present specific recommendations for integration and collaboration between the 2 approaches to improve the impact of QI and implementation efforts in the hospital setting.
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AF Agile Pathway – Ambulatory
AF Agile Pathway – Ambulatory
Heart Rhythm Society Expert Consensus Statement on Electrophysiology Laboratory Standards: Process, Protocols, Equipment, Personnel, and Safety
Guidelines/Clinical Documents: The modern electrophysiology (EP) laboratory is a complex environment providing an array of interventions for the diagnosis and treatment of heart rhythm disorders and is a result of many transformations over the last three decades. The EP field has witnessed rapid expansion in the number of therapeutic procedures treating a wide range of arrhythmias and in the new technologies available to perform these procedures. Because of the increasing complexity of equipment and procedures and an ever-expanding knowledge base, it was concluded that the field would benefit from a consensus document that would define the critical components and processes of a modern EP laboratory. To this end, the Heart Rhythm Society (HRS) convened a multidisciplinary team to review EP laboratory design, ergonomics, personnel, equipment, occupational hazards, and patient safety, as well as clinical and ethical issues related to diagnostic and therapeutic EP procedures. The goal is to provide physicians, administrators, and regulatory personnel with the recommended requirements for building, staffing, and running a modern EP laboratory to optimize patient outcomes, minimize patient risk, and provide a safe and positive environment for physicians and staff.
The writing committee was formed by the Scientific and Clinical Documents Committee of the HRS, with approval by the President of the HRS and the HRS Executive Committee. The composition of the committee was meant to represent the range of stakeholders in the EP laboratory. The choice of the writing committee members was in accordance with the HRS Relationships With Industry policy.1 All members of the writing committee were required to fully disclose all potential conflicts of interest (see Appendix 1).
Relatively little published literature addresses the EP laboratory environment, staffing, and processes. Therefore, many of the statements in this document are the product of expert consensus by the writing committee and reviewers. For cases in which there were divergent opinions on a statement, a vote among writing committee members was taken, and if a two-third majority supported the statement, it was adopted in the document. The sections pertaining to pediatric and adult congenital heart disease were reviewed and approved by the Pediatric and Congenital Electrophysiology Society (PACES), a nonprofit organization dedicated to the treatment of arrhythmia disorders in children and individuals with congenital heart disease (CHD). The final document was approved by the Board of Trustees of the HRS. This document is directed to all health care professionals who design, manage, and/or work in the EP laboratory environment.