Barriers to Implementing a Surgical Beta-Blocker Protocol

Background: Experience with a quality improvement (QI) program undertaken to increase the use of betaadrenergic blockade in at-risk patients at both a major academic medical center and a community hospital suggests barriers to implementation. Methods: A retrospective and prospective cohort study was performed to establish the incidence and effectiveness of beta-blockade use pre-and postimplementation of a standardized screening tool and a major education program as part of a QI project. Data gathering involved a baseline phase pre-intervention; 6 weeks postintervention; and 3-6 months postintervention. Results: During phase I (baseline) 56% of eligible patients received beta-blockers, but targeted measures (a pre-induction heart rate < 70 or a systolic blood pressure [BP] < 110 mmHg) were achieved in only 11% of patients. Phase II saw a significant overall increase in beta-blocker administration (79%) and efficacy (50%). However, during phase III (3-6 months postimplementation), the rate of beta-blocker administration fell to 61% overall, while overall efficacy remained stable at 52%. Significant differences between the academic and community hospitals were observed throughout the study. Conclusion: Implementation of a quality program for beta-blockade is significantly affected by the presence or absence of ongoing physician and staff education beyond the study period.