NURS FPX 8004 Assessment 2 Professional Practice Report
Student name
Capella University
NURS- FPX8004
Professor Name
Submission Date
NURS FPX 8004 Assessment 2 Professional Practice Report
The outpatient cardiopulmonary specialty clinic where I currently work is dedicated to treating adult patients with cardiopulmonary related issues. Pulmonary hypertension (PH) is an area of concern for our clinic due to the hyper generalized symptoms of fatigue and shortness of breath. Unfortunately, symptoms of PH are often dismissed or misdiagnosed as other, more common illnesses. These illnesses include bronchial asthma, chronic obstructive pulmonary disease (COPD), or congestive heart failure (Executive Nurse, personal communication, February 15, 2026). Correctly diagnosing PH can take many years, forcing patients to live with a misdiagnosis (Executive Nurse, personal communication, February 15, 2026). There is a general lack of PH awareness among the providers that do the preliminary testing and a general lack of accessible CP and pulmonary testing and referral integration (Executive Nurse, personal communication, February 15, 2026). There is a clear disconnect between the existing evidence based practice (EBP) recommendations for the early recognition of PH and the current practice at the clinic.
An important consideration in bridging this gap is the delay in diagnosis of this condition, if any, since it may lead to the progression of the condition and decreased quality of life. Based on the practice concern, there is a need to do a quality improvement effort to enhance the current practice regarding pulmonary hypertension. This may, then, have far-reaching consequences for the patient and the Health Care Organization. Patients and their families may suffer from worsening symptoms, decreased functional ability, and increased emotional and financial burden due to delayed diagnosis and treatment of the conditions (Kubota et al., 2023). Conversely, healthcare systems can experience a rise in hospitalizations, treatment challenges, and healthcare service utilization of patients who are diagnosed late with pulmonary hypertension (DuBrock et al. 2023). Furthermore, delayed diagnosis can impact the quality benchmarking of the healthcare organization with regards to timely diagnosis, timely treatment, and timely care for patients. One such project could be a quality improvement project aimed at improving the process for identifying pulmonary hypertension early and the effectiveness of referral streamlining to minimize delays in diagnosis and treatment of patients.
Problem Statement
Pulmonary hypertension is underdiagnosed and/or delayed in the outpatient cardiopulmonary clinic due to limited access to timely specialty evaluation and the inconsistent referral practices. The goal of implementing a quality improvement effort to improve early recognition and diagnosis of PH is to decrease the time to outpatient clinic specialty evaluation of patients with PH symptoms by 25% in 12 weeks of implementation.
Thesis Statement
The purpose of the quality improvement project is to reduce the time to diagnosis of pulmonary hypertension (PH) by educating providers, coordinating referrals, and implementing interprofessional collaboration within the practice environment. Thus, this approach would result in earlier identification of pulmonary hypertension patients, which would ensure timely access of patients presenting to the outpatient clinic with symptoms of pulmonary hypertension for specialty evaluation.
Population
The population of the practice site is adult patients >18 years of age, presenting with chronic cardiopulmonary symptoms and clinical suspicion of pulmonary arterial hypertension (PAH). The target patients exhibit symptoms such as increased dyspnea, fatigue, exercise intolerance, dizziness, and/ or chest discomfort. These symptoms warrant additional workups as they may be suggestive of underlying cardiopulmonary pathologies (Executive Nurse, personal communication, February 15, 2026). The population of focus for this quality improvement project are adult patients exhibiting symptoms/ dyspnea of unknown etiology and requiring further diagnostic workup to rule in/ out pulmonary hypertension (Executive Nurse, personal communication, February 15, 2026). Of all the patients who appear in the clinic with dyspnea of unknown origin, the percentage of those whose diagnosis and treatment are delayed is around 35%, and the delay in diagnosis is more than 4 weeks. Furthermore, within the organization, it was found that approximately 28% of people with pulmonary hypertension were not referred to pulmonary hypertension clinics. Adult patients who present to the clinic with cardiopulmonary symptoms and are determined to require specialty care for pulmonary hypertension because of these symptoms are included in the quality improvement initiative. These exclusion criteria would include pediatric patients, patients with a previous diagnosis of advanced pulmonary hypertension who are already receiving specialist care, and patients who are only receiving treatment for other unrelated heart and lung diseases. Another population that would be relevant to the practice change is the healthcare professionals and staff at the practice site who would be involved in the process of change, such as physicians, nurse practitioners, registered nurses, and referral coordinators, who would evaluate symptoms, order tests for patients, and assist with referrals to specialists for pulmonary hypertension.
Stakeholders
At the outpatient cardiopulmonary specialty clinic, there are several key stakeholders that are involved in addressing the practice issue of delayed diagnosis/referral for pulmonary hypertension. Main stakeholders include healthcare professionals who assess and manage patients with cardiopulmonary complaints and who make referrals for pulmonary hypertension. These include Physicians, Nurse Practitioners, Registered Nurses, and Respiratory Therapists. Stakeholders also include employees in healthcare organizations at the managerial level, particularly those responsible for managing and leading quality improvement teams. These employees are responsible for the operational aspects of quality and safety compliance (Spitzer et al., 2022). The stakeholders impacted by the practice problem – patients and families – who are likely to suffer from lower quality of life and poorer health outcomes due to the lack of timely diagnosis and treatment of pulmonary hypertension. There are different concerns for each stakeholder group that must be considered. The providers would probably be more interested in ensuring the efficiency of work and would be resistant to anything that would make the job more complicated, such as additional documentation or referrals, so communications should focus on simplicity and benefits for patients. Information should be provided in terms of the outcomes and efficiency of patient care as it relates to performance measures and costs, to those who have leadership roles in the organization.
Communication plans will be created to reach each stakeholder, and to ensure understanding and cooperation to the quality improvement initiative. Healthcare providers will receive education about what the evidence-based practice is to recognize the signs and symptoms of pulmonary hypertension and timely referral to specialty care. Last, patients and families will be provided with information on the importance of follow-up care and what to expect during the follow-up process (Elizalde et al., 2024). Furthermore, the project will make sure that stakeholders at the practice site cooperate and collaborate with the quality improvement process by using teamwork, decision making, and communication. This will be done by involving the clinical staff in the planning process, training the staff, and sharing information about the progress of the quality improvement initiative.
PICOT Question Development
For a nurse caring for patients diagnosed with pulmonary hypertension in an outpatient cardiopulmonary clinic (P), how does implementing a standardized pulmonary hypertension screening and referral protocol (I), compared with the current standard practice (C), affect the time to specialty referral (O), within 12 weeks?
- P (Population): Nurses caring for patients with pulmonary hypertension in an outpatient cardiopulmonary clinic
- I (Intervention): Implementation of a standardized pulmonary hypertension screening and referral protocol
- C (Comparison): Current standard referral process
- (Outcome): Time to specialty referral
- T (Time): 12 weeks
The PICOT approach is used to guide the quality improvement initiative, aimed at tackling the issue of delayed recognition and referral to the cardiopulmonary specialty clinic in the outpatient setting for patients suspected of having pulmonary hypertension. To improve the quality, the proposed project will implement a standardized pulmonary hypertension screening and referral protocol to resolve the issue of inconsistent screening and referral for patients with suspected pulmonary hypertension. The goal of the project will be judged by comparing the length of time to referral among patients with suspected pulmonary hypertension who have been referred for evaluation between the pre- and post- intervention periods within a 12-week period.
Conclusion
Pulmonary hypertension remains a complex disorder and is progressive in nature, and should be rapidly identified and referred to prevent worsening of the disease or a more favourable prognosis. Outpatient cardiopulmonary specialty clinic practice problem suggests that patients may not be identified for pulmonary hypertension (PH) in a timely manner, and no referral to a cardiologist may be made if needed. To enhance practice, it is important to think about the patient population that is impacted, who all the stakeholders will be, and to form a PICOT question so there is a foundation for addressing the practice gap.
References
DuBrock, H. M., Germack, H. D., Loiselle, M. G., Linder, J., Satija, A., Manceur, A. M., Cloutier, M., Lefebvre, P., Panjabi, S., & Frantz, R. P. (2023). Economic burden of delayed diagnosis in patients with pulmonary arterial hypertension (PAH). PharmacoEconomics – Open, 8, 133–146. https://doi.org/10.1007/s41669-023-00453-8
Elizalde, J., Lizarondo, L., & Corpuz, J. R. (2024). Barriers and facilitators to health professionals’ engagement in quality improvement initiatives: A mixed-methods systematic review. International Journal for Quality in Health Care, 36(2). https://doi.org/10.1093/intqhc/mzae041
Kubota, K., Miyanaga, S., Akao, M., Mitsuyoshi, K., Iwatani, N., Higo, K., & Ohishi, M. (2023). Association of delayed diagnosis of pulmonary arterial hypertension with its prognosis. Journal of Cardiology, 83(6), 365–370. https://doi.org/10.1016/j.jjcc.2023.08.004
Pulmonary Hypertension Association. (2026, January 21). Your PH care team. PH Association. https://phassociation.org/living-with-ph/managing-your-health/your-ph-care-team
Spitzer, K. A., Stefan, M. S., Priya, A., Pack, Q. R., Pekow, P. S., Lagu, T., Mazor, K., Plata, V. M. P., Bradley, K., Heineman, B., ZuWallack, R. L., & Lindenauer, P. K. (2022). Promoting participation in pulmonary rehabilitation following hospitalization for chronic obstructive pulmonary disease: Strategies of top-performing systems. A qualitative study. Annals of the American Thoracic Society, 20(4), 532–538. https://doi.org/10.1513/annalsats.202203-237oc
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