title: Barriers to implementing a surgical beta-blocker protocol.
abstract: BACKGROUND
  Experience with a quality improvement (QI) program undertaken to increase the use of beta-adrenergic 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 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Beth Israel Medical Center, New York City, NY, USA. michael.cantor@med.nyu.edu
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cantor
authors.forename: Valentina
authors.initials: V
authors.lastname: Lavarias
authors.forename: Steven
authors.initials: S
authors.lastname: Lam
authors.forename: Lauren
authors.initials: L
authors.lastname: Mount
authors.forename: Violetta
authors.initials: V
authors.lastname: Laskova
authors.forename: Vadim
authors.initials: V
authors.lastname: Nakhamiyayev
authors.forename: Yakov
authors.initials: Y
authors.lastname: Bier
authors.forename: Dino
authors.initials: D
authors.lastname: Paiusco
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Antonacci
mesh_terms: D000046:Academic Medical Centers; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy; D002985:Clinical Protocols; D015331:Cohort Studies; D004059:Diffusion of Innovation; D004305:Dose-Response Relationship, Drug; D006764:Hospitals, Community; D006801:Humans; D016528:Postanesthesia Nursing; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists