TABLE 1

10-Step Case Study: Adequacy of Patient Preparation for Pharmacologic Stress

Stage	Step	Description
Plan	Identify problem	Nuclear cardiology laboratory that performs exercise and pharmacologic stress myocardial perfusion imaging notices that many patients arrive for appointment carrying large cup of coffee from new shop next door. It would be easy to assume that presence of shop is cause of problem. However, practice decides to investigate if other factors could be involved.
	Gather information	Laboratory gathers information about its current procedures, looking at patient preparation form, scheduling process, and patient confirmation process.
	State goal and set targets	Laboratory sets goal of improving patient compliance with caffeine restriction before myocardial perfusion imaging.
		Laboratory wants 90% of patients to be in compliance with patient preparation instructions.
	Design data collection strategy	Laboratory creates simple form to record patient name, whether patient consumed caffeine within 18 h of test, staff member who scheduled patient, date patient was scheduled, referring office and its staff member who scheduled patient, staff member who confirmed appointment before test, date appointment was confirmed, and whether preparation instructions were personally discussed with patient.
		Laboratory decides, for 2 wk, to survey every patient scheduled for myocardial perfusion imaging.
Do	Collect data	For 2 wk, laboratory surveys every patient scheduled for myocardial perfusion imaging.
	Analyze data	Laboratory compiles data into spreadsheet and highlights data associated with patients who consumed caffeine or for other reasons were inadequately prepared for examination. Percentage of patients inadequately prepared is calculated.
Study	Share results	Laboratory schedules staff meeting.
	Select action plan	After examining data, laboratory realizes that most caffeine-consuming patients came from one referring office. In addition, many of those patients were not personally reached by staff member responsible for confirming test.
		Plan is formulated to educate culprit referring office and to revise patient instruction form to highlight importance of caffeine restriction.
Act	Implement change	Laboratory does in-service training with all staff and conducts lunch-and-learn session with culprit office to emphasize importance of appropriate patient preparation and consequences of inappropriate preparation. Revised patient preparation form is provided to culprit office.
	Repeat	Laboratory then repeats data collection for 2 wk and notices decrease in number of coffee-drinking arrivals who were scheduled from culprit office.
		Laboratory decides to conduct lunch-and-learn sessions and provide new form to all referring physician offices.