Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2020


Doctor of Nursing Practice (DNP)


Background: The hospital’s post- myocardial infarction (MI) referral protocol does not address patient risk characteristics. Referrals to a post- MI clinic have been lower than expected. Evidence suggests the AMI READMITS score can predict readmissions within 30 days after discharge among patients with acute MI.

Aim: This quality improvement study evaluated a referral protocol that integrated the AMI READMIT score to increase appropriate referrals after discharge.

Methods: Patient chart data was analyzed to assess changes in referrals and timely follow-up from pre-intervention to intervention. A survey assessed providers’ satisfaction with the new referral protocol.

Results: Among 57 patients (n=29 pre-intervention; n=28 intervention), documented referrals increased significantly from 66% to 89% (χ2=4.571, df=1, p= 0.033); and timely appointments increased by 10%, which was not significant (χ2=3.550, df=2, p= 0.169). Most providers agreed the new protocol was easy to use, useful in making referral decisions and improved the referral process. All agreed the risk score should be incorporated into electronic clinical notes via smart phrase. Provider opinions related to implementing the risk score in clinical practice were mixed. Qualitative feedback suggests this was due to lack of validation of the AMI READMITS score in reducing readmissions.

Conclusions: This study demonstrated that an evidence-based referral protocol can increase appropriate referrals among patients with MI. Provider adoption may be enhanced by incorporating the protocol into electronic clinical notes. Future research to validate the accuracy AMI READMITS score in predicting readmissions could further support the implementation of the protocol in clinical practice.

Open Access


Available for download on Wednesday, April 20, 2022

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