CMC Quality Assurance & Improvement 4 — Questions and Answers
Question 1: A hospital's cardiac surgery program is a significant outlier on risk-adjusted mortality in the STS database. What is the most appropriate first step?
- Conduct a detailed case review and internal audit to identify patterns contributing to excess mortality (Correct answer)
- Immediately suspend all elective cardiac surgery
- Report the finding to state health authorities before investigation
- Attribute the difference to inaccurate risk modeling and take no action
Correct answer: Conduct a detailed case review and internal audit to identify patterns contributing to excess mortality
When a significant outlier signal appears, the first step is a rigorous internal case review and audit to determine whether the variation reflects true quality gaps or data/coding issues.
Question 2: Which quality framework uses 'Aim, Measures, Changes' as its three foundational questions?
- The Model for Improvement (Institute for Healthcare Improvement) (Correct answer)
- Six Sigma DMAIC methodology
- Lean Value Stream Mapping
- ISO 9001 Quality Management System
Correct answer: The Model for Improvement (Institute for Healthcare Improvement)
The IHI Model for Improvement asks: What are we trying to accomplish? How will we know a change is an improvement? What changes can we make that will result in improvement?
Question 3: In Six Sigma applied to cardiac care, what does a defect represent?
- Any instance where a patient does not receive a specified evidence-based care element (Correct answer)
- A medication error resulting in patient harm
- A device malfunction during a cardiac procedure
- Any deviation from normal sinus rhythm during monitoring
Correct answer: Any instance where a patient does not receive a specified evidence-based care element
In Six Sigma, a defect is defined as any failure to meet a customer (patient) requirement or specified standard of care, allowing mathematical quantification of process performance.
Question 4: A cardiac ICU implements a checklist for daily goal-setting during rounds. This intervention targets which domain of the IOM's six aims for quality health care?
- Safe and Effective
- Efficient and Timely
- Equitable and Patient-Centered (Correct answer)
- Effective and Patient-Centered
Correct answer: Equitable and Patient-Centered
Daily goal checklists during ICU rounds improve team communication about the patient's care plan, addressing patient-centered care and effectiveness of care delivery.
Question 5: Which of the following is the primary purpose of a Failure Mode and Effects Analysis (FMEA) in cardiac quality management?
- To prospectively identify potential process failures and their impact before they cause patient harm (Correct answer)
- To analyze all adverse events that occurred in the past year
- To rank nursing staff performance based on error frequency
- To document equipment failures for insurance purposes
Correct answer: To prospectively identify potential process failures and their impact before they cause patient harm
FMEA is a proactive risk assessment tool that systematically identifies how a process might fail and prioritizes preventive actions based on severity, occurrence, and detectability.
Question 6: According to ACC/AHA performance measures, which of the following is a Class I recommended discharge medication for patients hospitalized with reduced ejection fraction heart failure?
- ACE inhibitor or ARB plus beta-blocker plus aldosterone antagonist (if appropriate) (Correct answer)
- Digoxin and loop diuretic only
- Calcium channel blocker and statin
- Anticoagulation with warfarin regardless of rhythm
Correct answer: ACE inhibitor or ARB plus beta-blocker plus aldosterone antagonist (if appropriate)
Guideline-directed medical therapy for HFrEF at discharge includes ACE inhibitor/ARB (or ARNI), evidence-based beta-blocker, and aldosterone antagonist when tolerated and appropriate.
Question 7: A QI coordinator notices that physician documentation of left ventricular ejection fraction is missing in 40% of heart failure discharges. Which QI tool would best display which physicians account for the majority of this gap?
- Pareto chart (Correct answer)
- Run chart
- Control chart
- Scatter diagram
Correct answer: Pareto chart
A Pareto chart ranks contributors by frequency, visually showing that roughly 80% of a problem often comes from 20% of causes — ideal for identifying the physicians responsible for most documentation gaps.
CMC Quality Assurance & Improvement 4
A hospital's cardiac surgery program is a significant outlier on risk-adjusted mortality in the STS database.
What is the most appropriate first step?