9 PUBLIC HEALTH

Final Project Charter

SWOT Analysis

Strengths, weaknesses, opportunities, and threats (SWOT) analysis is a framework that helps an organization analyze an organization’s competitive standing. It evaluates an organization based on its strengths, weaknesses, opportunities, and threats. Strengths and weaknesses are current internal aspects, while opportunities and threats are future external factors (“SWOT analysis,” 2018). In this assessment, a SWOT analysis is conducted to identify the SWOT of the Coronary Artery Disease Reduction and Early Detection (CADRED) project, which focuses on reducing the mortality rate due to ST elevation myocardial infarction (STEMI) through early diagnosis and treatment at SG Hospital. The conventional treatment procedures for STEMI are fibrinolytic therapy and percutaneous coronary intervention (PCI).

Strengths

· The project team is made up of individuals with demonstrated skills and remarkable experiences that are relevant to the project.

· The project will focus on the quality measures of the organization through an improvement in key statistics such as mortality rate.

· Using electronic health records (EHRs) will improve quality of care provided to patients.

· The high-priority status of the project will ensure immediate intrahospital transfer for patients who require special care, which will improve patient retention and the care given to patients.

· Additionally, there are adequate referral protocols in place to prevent all forms of referral leakage.

Weaknesses

· Patients who have incomplete medical records may have more risks than estimated because of insufficient data about contraindications.

· There is no guarantee that patients will follow postprocedural guidelines such as stopping smoking or changing their diet, which are necessary for them to maintain their health after PCI or fibrinolytic therapy.

· Studies by Cheng et al. (2019) suggest that there is a high chance of incidence of restenosis after PCI. This may not be diagnosed in patients after PCI if they do not return for subsequent checkups. This increased risk of restenosis is seen in women, individuals with unstable angina, and individuals with myocardial infarction.  Postoperative symptoms such as anxiety and depression may be overlooked.

Opportunities

· The use of EHRs and the latest ECG technology will provide sufficient significant data that will allow the automation of the diagnosis process, leading to accurate results.

· Psychological therapy may be recommended for patients who display postoperative symptoms such as anxiety and depression, decreasing referral leakage.

· Fibrinolytic therapy is effective at reducing the likelihood of medical conditions such as myocardial infarction that have an elevated risk of occurrence in patients who smoke and have bad dietary habits.

· The project also creates the opportunity to raise awareness about lifestyle choices that will help prevent coronary artery diseases or help in successful recovery.

Threats

· The risk of hemorrhagic complications following fibrinolytic therapy cannot be monitored effectively. This will reduce the success rate of the therapy.

· The treatment provided can be affected in certain rare cases in which patients may not show any clinical symptoms of restenosis.

· There may be a slight risk of allergic reactions to the contrast dye and an even smaller risk of infection after PCI.

Known Major Risks

Communication is a necessary skill in clinical practices and for the success of the project. It helps foster trust and coordination within the team and improve patient satisfaction (Lewis et al., 2016). SG Hospital has a digital internal communication network, which has made internal operations efficient. The project team has excellent interpersonal communication skills that allow for effective communication between different team members, external departments, and patients. The team follows the Situation-Background-Assessment-Recommendation technique, which is a communication model employed during transitions. This technique helps communicate information in a structured manner within the team and avoid miscommunication (Lewis et al., 2016).

Regular progress updates will be shared with the hospital team by the project manager through weekly team meetings. The project manager will also give a detailed report of the progress of the project to the CEO, CCO, and the board of directors on a monthly basis. This report will be a PowerPoint presentation and will cover all metrics that will evaluate the performance of the project. Gantt charts will be used to record and display the timelines of all the cases and to understand if there are better ways of scheduling for efficiency. Gantt charts will also be used to document the milestones of the project. There will also be a comprehensive report after every 3 months, which will cover a detailed analysis of the project and projections for the future.

Proposed Outcomes

Metric

Outcome Measure

Process Measure

Countermeasure (optional)

In-hospital risk-adjusted mortality

Perioperative mortality in hospital among patients 18

years of age and older adjusted for the level of risk to the total number of patients 18 years of age and older on whom PCI was performed.

The drugs administered on the arrival of a patient are recorded.

Door-to-balloon (D2B) during emergency cardiac care is recorded separately for transferred patients

(patients on whom PCI was performed after a referral from a hospital without the PCI facility) and nontransferred patients (patients on whom PCI was performed in the hospital of admission). Procedural complications, if any, that death is attributed to are not recorded or tested for.

Patients’ medical history is to be considered carefully,

and all preoperative tests and perioperative monitoring must be done as per protocol.

PCI risk-adjusted bleeding

Patients 18 years of age and older with a post-PCI bleeding event as a ratio to the total patients above 18 on whom PCI was performed after admission.

The drugs administered on the arrival of a patient and those prescribed at discharge are recorded. Patients who die within 24 hours of the procedure are excluded. Also, cases that indicate undetected contraindications due to oversight of information or unverified external data are not tested for.

N/A

30-day readmission rate

Number of patients 18 years of age and older admitted for care within 30 days of discharge to

the total number of patients 18 years of age and older

discharged from the hospital.

As per the 2010–2014 National

Readmission database, the 30day readmission rate in the U.S.

is 12.3%, and this results in a cumulative cost increase of 47.9% (Kim et al., 2018).

Drugs administered on the arrival of a patient and those

prescribed at discharge are recorded along with the

patient’s testimony on their adherence to recommended

lifestyle changes. The cause of readmission is recorded.

N/A

Data Collection Plan

Data collection and maintenance are essential for the right diagnosis and treatment of any given case. A patient’s database includes the patient’s medical history and results from lab tests and diagnostic tests. Secondary data on the patient’s history will be transferred on a case-by-case basis when the referral is internal. When the referral is external, contraindications must be verified through tests and recorded. The data from the required tests before, during, and after treatment are recorded in EHRs. Primary data regarding health status are recorded by the cardiologist or the nurse to whom the duty is delegated. The confidentiality of information will have the foremost consideration. It should be ensured that a legal release is obtained from the patient before the data is used for evaluating the project, as mandated by HIPAA (Bowen, 2018). The transfer of all data is recorded in the database in a systematic manner. This will help avoid oversights such as using data without patients’ consent. Data collection is vital in verifying the success of the project in terms of measured outcomes. This data will be used to validate the importance of the project to the stakeholders. The data used for this purpose will be collected through Excel for analysis and subsequent presentation.

Data Collection Tool

Using Excel, develop a data collection tool, using appropriate headers for columns and rows.

· Sheet 1: The data collection tool should include at least one filtering application and one analytical function (sum, mean, calculation).

· Sheet 2: Add dummy data to demonstrate the operation above.

· Sheet 3: Based on the dummy data, create a graphic representation (such as histogram, line graph, bar graph, or pie chart) to show how the data can be displayed and communicated.