CMC Quality Assurance & Improvement 3 — Questions and Answers
Question 1: A cardiac program wants to reduce 30-day heart failure readmissions. Which intervention has the strongest evidence for this outcome?
- Structured transitional care with early follow-up and nurse telephone support (Correct answer)
- Extending inpatient stay by 48 hours for all HF patients
- Mandatory daily weights without nurse coaching
- Prescribing loop diuretics to all discharged patients regardless of volume status
Correct answer: Structured transitional care with early follow-up and nurse telephone support
Structured transitional care programs including pre-discharge education, early post-discharge follow-up, and telephone support have the strongest evidence for reducing HF readmissions.
Question 2: In Lean methodology applied to a cardiac catheterization lab, which of the following best describes 'waste' (muda)?
- Unnecessary patient transport between departments that adds no clinical value (Correct answer)
- Time spent reviewing angiographic images before PCI
- Documentation required for Joint Commission accreditation
- Post-procedure monitoring in the recovery area
Correct answer: Unnecessary patient transport between departments that adds no clinical value
In Lean, waste includes any activity consuming resources without adding value to the patient — unnecessary transport between departments is a classic example of motion/transport waste.
Question 3: A QI team finds that only 60% of STEMI patients receive aspirin within 10 minutes of arrival. Using a cause-and-effect analysis, which category would 'no aspirin stocked in triage' fall under?
- Materials/Equipment (Correct answer)
- People
- Methods
- Environment
Correct answer: Materials/Equipment
In a fishbone (Ishikawa) diagram, absence of a required supply like aspirin in triage falls under the 'Materials' (or Equipment) category.
Question 4: Which of the following best defines a 'sentinel event' in the context of The Joint Commission standards for cardiac care?
- An unexpected event resulting in death or serious physical harm not related to the natural course of the patient's illness (Correct answer)
- Any adverse drug reaction requiring a medication change
- A readmission within 30 days of cardiac surgery discharge
- A patient complaint regarding nursing care during hospitalization
Correct answer: An unexpected event resulting in death or serious physical harm not related to the natural course of the patient's illness
The Joint Commission defines a sentinel event as an unexpected occurrence involving death or serious physical or psychological harm, or the risk thereof, signaling the need for immediate investigation.
Question 5: In cardiac quality reporting, what is the purpose of risk adjustment?
- To allow fair comparison of outcomes across hospitals serving populations with different levels of illness severity (Correct answer)
- To reduce the number of patients included in quality reports
- To exclude outlier cases that skew average performance data
- To give higher performance scores to hospitals treating sicker patients
Correct answer: To allow fair comparison of outcomes across hospitals serving populations with different levels of illness severity
Risk adjustment accounts for differences in patient case mix so that outcomes reflect care quality rather than patient demographics or comorbidity burden.
Question 6: A catheterization lab implements a huddle each morning to review the day's case list for safety concerns. This practice is an example of which quality and safety concept?
- Proactive risk identification (prospective safety review) (Correct answer)
- Retrospective root cause analysis
- Peer review for credentialing purposes
- Incident reporting and near-miss documentation
Correct answer: Proactive risk identification (prospective safety review)
Pre-procedure or pre-shift huddles proactively identify potential safety hazards before they occur, which is a prospective safety review strategy.
Question 7: Which of the following is the best description of a 'process measure' in cardiac quality improvement?
- Whether eligible MI patients received beta-blockers at discharge (Correct answer)
- 30-day mortality rate after coronary artery bypass grafting
- Patient satisfaction scores following cardiac catheterization
- Readmission rate within 90 days of heart failure hospitalization
Correct answer: Whether eligible MI patients received beta-blockers at discharge
Process measures assess whether specific evidence-based care steps were performed (e.g., prescribing beta-blockers at discharge), as opposed to outcome measures that capture end results.
CMC Quality Assurance & Improvement 3
A cardiac program wants to reduce 30-day heart failure readmissions.
Which intervention has the strongest evidence for this outcome?