P2.B035: Implementation of the 2023 American College of Cardiology (ACC) Clinical Practice Guidelines for the Follow-up of Repaired Coarctation of the Aorta

Purpose/Objectives: In 2023, the American College of Cardiology (ACC) published a clinical practice algorithm to provide evidence-based recommendations for the follow-up of patients with repaired coarctation. This matches the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents published by the American Academy of Pediatrics (AAP) in 2017 which included: “HTN can be a manifestation of re-coarctation. Re-coarctation in repaired patients should be assessed by using 4 extremity BP measurements and echocardiography. HTN can also occur without re-coarctation". A review of our electronic medical record (EMR) for the 2023 fiscal year demonstrated a rate of obtaining upper and lower extremity blood pressures (BP) in patients with repaired coarctation of 14 %. The SMART aim of this project was to improve this rate to more than 50% within 6 months and demonstrate sustainability for an additional 6 months by improved implementation of the 2023 ACC and the 2017 AAP Clinical Practice Guidelines.

Design/Methods: This is an IRB-approved observational time series study with sequential interventions of Plan-Do-Study-Act (PDSA). The study took place at our Pediatric Cardiology Clinic in Detroit, MI. Inclusion criteria included patients who underwent coarctation repair and are being seen for an outpatient follow-up. Before starting the PDSA cycle interventions, the research staff did a root cause analysis and summarized key drivers (Figures1,2). Thus far, we have performed one PDSA cycle that was identified in the key driver diagram and included: 1) education intervention of clinic staff and formalization of workflow and 2) a weekly email sent to the clinic staff on which patients need upper and lower extremities BP. Each month a retrospective chart review was performed on those patients meeting the inclusion criteria and recorded if upper and lower extremity BP was performed and documented in the chart.

Results: Review of our EMR for the first 8 weeks post implementation of PDSA cycle 1 showed an improvement in the rate of obtaining upper and lower extremities blood pressure to 78 % in patients with repaired coarctation of the aorta.

Conclusion/Discussion: Education intervention and email reminders for upper and lower extremity BP to improve staff workflow have led to improvement in the rates of obtaining upper and lower extremity BP in patients with repaired coarctation of the aorta. For the next PDSA cycle, we would like to have formal order sets that can be placed in the patient's EMR by the primary cardiologist for the clinic staff to know which patients need upper and lower extremity BP. This aims to provide clinic staff with clear guidance on which patients require upper and lower extremity blood pressure assessments, thereby reducing reliance on weekly email reminders and ensuring sustained compliance toward maintaining our SMART aim.