Process Evaluation of a Quality Improvement Project
Research type
Research Study
Full title
Implementing an atrial fibrillation care pathway in an implantable device clinic: a process evaluation of a quality improvement project
IRAS ID
170966
Contact name
Andy Healey
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
0 years, 5 months, 29 days
Research summary
Atrial fibrillation (AF) and atrial flutter (AFL) are abnormal heart rhythms arising when electrical impulses controlling the heart become disorganised, causing irregular heart beats. Episodes of AF or AFL are sometimes self-limiting or may be persistent, and can go undetected where no symptoms are experienced or mild symptoms do not cause concern. Patients with implantable cardiac devices (such as a permanent pacemaker) for other cardiac conditions undergo regular device checks in the cardiac physiology clinic. Episodes of AF or AFL which may have gone unnoticed by patients are detected when the device is reviewed by the cardiac physiologist.
AF and AFL significantly increase the risk of blood clot formation and stroke. Anticoagulant medications are used to reduce the risk of stroke. Updated guidelines presenting the best evidence for assessing stroke risk in AF and AFL, and appropriate anticoagulation were published by the National Institute for Health and Care Excellence (NICE) in June 2014. Stroke has a huge human impact with potentially devastating effects on patients and their families, and the costs to the National Health Service are significant.
A care pathway, integrating the NICE guidelines into practice, is being developed as a quality improvement project in the cardiac device clinic at St Thomas' Hospital. As part of the project we will conduct research into the processes by which the care pathway is introduced, and evaluate and monitor the influences on how it is embedded and sustained in clinical practice. We will examine barriers to the planned process and what helped staff to make changes to introduce the pathway. This is called a process evaluation and it will inform us about how change is introduced to improve health services effectively. It will add to knowledge about the science of improvement so that local learning may be used in other contexts.
REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
15/WM/0395
Date of REC Opinion
20 Oct 2015
REC opinion
Favourable Opinion